“Sun, sand, surf, and surgery in Thailand”

Sun, sand, surf and surgery in Thailand 1

Mälardalen University

School of Business ZAY01 International Marketing EX0110 Master Thesis Tutor: Tobias Eltebrandt

“Sun, sand, surf, and surgery in Thailand”

Authors: group 1214

Chittree Yokyongsakul 591116

Ticha Chookham 790822

Sun, sand, surf and surgery in Thailand i

Abstract

Date: June 15, 2006

Program: MIMA - International Marketing

Course: EX 0110 Master Thesis

Authors: Chittree Yokyongsakul [email protected]

Ticha Chookham [email protected]

Tutor: Tobias Eltebrandt

Title: Sun, sand, surf and surgery in Thailand

Problems: How can Thai private hospitals increase the number of medical tourists from Sweden?

Purpose: To analyze the potential for private hospital in Thailand from a medical tourism perspective, to study the demands of Swedish medical tourists and to suggest a suitable health and medical care package with tourism for this market.

Methodology: This thesis is based on a combination of both qualitative and quantitative research. The major theory used is the Collaborative Strategic Tourism marketing planning process from the book, Tourism Marketing: a collaborative approach, by Fyall & Garrod (2005). The data collection is categorized into two sources, primary and secondary. The primary data came from interviews and survey research and the secondary data was gathered from textbooks, journals and academic articles. The reliability and validity of all information was checked before use to ensure the accuracy of all material presented.

Conclusion: Medical tourism is a niche market of the tourism industry that is now being promoted by the Royal Thai Government as part of its drive to make Thailand the Healthcare Hub of Asia. Bangkok Hospital Phuket is a private hospital, which aims to be a supplier in this business, and with this in mind, it has invested in new buildings, technology, equipment and human resources. Entering the Swedish market, the hospital signed a contact with RelaxU, an agent in Sweden. However, the survey research from 400 Swedish respondents illustrates that Swedes do not presently have much demand for medical treatments in Thailand even though they may face lengthy waiting times for medical treatment at local hospitals. Although Bangkok Hospital Phuket has a number of strengths and is well prepared as a medical tourism provider, the hospital faces numerous threats due to Swedish people’s poor perception of medical service quality in Thailand and the physical distance between the two countries. In offering suitable health and medical care packages with tourism for this market, the hospital should segment its customers into two groups. Firstly, tourists who travel primarily for leisure and wish to include a simple treatment during their holiday, and secondly tourists who come specifically medical treatment at the hospital but wish to spend just a couple days of leisure time in the area. The hospital should offer different service packages for each segment with the same standard of quality.

Recommendation: Marketing communication should be taken into consideration as a major factor to possible success. The hospital has the potential to provide medical treatments to foreigners but the targeted customers have very little information with regard to the range of services available and also need reassurance about service quality. The cooperation of the tourism business network may be necessary to increase the demand for such services. Further studies into tourism business collaboration should be undertaken since there are several organizations involved in the medical tourism process. An interactive focus group research study may be necessary in order to ascertain the demands of specifically medical treatment tourists.

Key words: Medical tourism, Phuket, attraction, hospital, healthcare, collaborative

Sun, sand, surf and surgery in Thailand ii

Acknowledgement

One of the most pleasant parts of writing a thesis is the opportunity to thank all those who contributed

their efforts to our work. This report would not be complete without the support and assistance of a

number of people. First, we would like to thank our tutor, Mr. Tobias Eltebrandt, who kindly advised us

and corrected our paper. Thank you to Ms. Charlotta Edlund for her useful guidance. We also have

high regard for the management of Bangkok Hospital Phuket and the Tourism Authority of Thailand in

Stockholm. We cannot forget to thank Professor Roland Svensson at Mälardalen University and Dr.

Lennart Bogg from Karolinska Instutet for kindly providing information about the Swedish healthcare

system. We are very grateful to Mr. Stanley R. Clayton, the Deputy for Operations, Electromagnetic &

Advanced Technology Division; SPAWAR Systems Center-San Diego, USA, who found time in his

schedule to kindly edit our paper. Thank you also to Dr. Leechai Panyawongngam, a researcher and

approved thesis reader from Rajamangala University of Technology Krungthep, Thailand, who kindly

helped us check the construct validity of our research questionnaire, and Ms Tatiya Ongsiriporn of the

Information System Department at the same university, who helped us process the survey results with

the SPSS program. Lastly, we would like to thank all those who took the time to answer our

questionnaires.

Västerås, June 15, 2006

Sun, sand, surf and surgery in Thailand iii

Table of contents Abstract......................................................................................................................................................i Table of contents ..................................................................................................................................... iii List of figures ...........................................................................................................................................vi List of tables ............................................................................................................................................vi List of Abbreviations and Definitions ...................................................................................................... vii 1 Introduction.................................................................................................................................... 2 1.1 Background ................................................................................................................................ 2 1.2 Problem identification ................................................................................................................. 2 1.3 Purpose ...................................................................................................................................... 3 1.4 Target group ............................................................................................................................... 3 1.5 Disposition .................................................................................................................................. 3 1.6 Delimitation................................................................................................................................. 3 2 Methodology .................................................................................................................................. 4 2.1 Topic selection............................................................................................................................ 4 2.2 Literature review ......................................................................................................................... 4 2.3 Choosing the research methods ................................................................................................ 5 2.4 Research model ......................................................................................................................... 5 2.5 Developing the theoretical framework ........................................................................................ 6 2.6 Collecting information ................................................................................................................. 6 2.6.1 Primary data ........................................................................................................................... 6 2.6.1.1 Interviews ............................................................................................................................... 7 2.6.1.2 A survey research .................................................................................................................. 7 2.6.2 Secondary data .................................................................................................................... 10 2.7 Validity and reliability ................................................................................................................ 10 2.7.1 Primary data ......................................................................................................................... 10 2.7.2 Secondary data .................................................................................................................... 11 2.8 Criticism of the method............................................................................................................. 11 3 Theoretical Frameworks ............................................................................................................. 13 3.1 Definition of medical tourism .................................................................................................... 13 3.2 The tourism model................................................................................................................... 14 3.3 The collaborative strategic tourism marketing planning process ............................................. 16 3.3.1 Situational analysis .............................................................................................................. 16 3.3.2 Strategic tourism marketing planning................................................................................... 17 3.3.3 Strategic tourism marketing implementation and control.................................................... 19 3.4 SWOT analysis......................................................................................................................... 20 3.5 The tourism marketing mix ....................................................................................................... 21 3.5.1 Product ................................................................................................................................. 21 3.5.2 Price ..................................................................................................................................... 21 3.5.3 Place .................................................................................................................................... 22 3.5.4 Promotion ............................................................................................................................. 23 3.5.5 People .................................................................................................................................. 23 3.5.6 Process ................................................................................................................................ 23 3.5.7 Physical evidence ................................................................................................................ 24 3.5.8 Partnership ........................................................................................................................... 24 3.6 Summary of theoretical framework........................................................................................... 24 4 Empirical Finding ........................................................................................................................ 26 4.1 Medical tourism in Thailand...................................................................................................... 26 4.1.1 Thailand in brief.................................................................................................................... 26 4.1.1.1 Economy .............................................................................................................................. 26 4.1.1.2 Politics .................................................................................................................................. 27 4.1.1.3 Technology........................................................................................................................... 28 4.1.1.4 Environment ......................................................................................................................... 29 4.1.1.5 Social/ Culture...................................................................................................................... 29 4.1.2 The situation of medical tourism in Thailand........................................................................ 29 4.1.3 Tourism promoters ............................................................................................................... 32 4.1.4 Tourism service suppliers .................................................................................................... 33 4.2 Targeting the Swedish market.................................................................................................. 34 4.2.1 Sweden in brief .................................................................................................................... 34

Sun, sand, surf and surgery in Thailand iv

4.2.1.1 Economic.............................................................................................................................. 35 4.2.1.2 Population in Sweden .......................................................................................................... 36 4.2.2 Healthcare situation in Sweden ........................................................................................... 36 4.2.2.1 The structure of healthcare program in Sweden.................................................................. 36 4.2.2.2 The problem in the care systems......................................................................................... 37 4.2.2.3 Privatization of hospitals in Sweden .................................................................................... 38 4.2.3 Swedish traveling behavior .................................................................................................. 39 4.2.3.1 The purpose of visits ............................................................................................................ 39 4.2.3.2 Expenditures ........................................................................................................................ 40 4.2.3.3 Type of Swedish tourists and their behavior ........................................................................ 41 4.2.3.4 The attraction of Phuket ....................................................................................................... 41 4.3 Bangkok Hospital Phuket ......................................................................................................... 42 4.3.1 Overview .............................................................................................................................. 42 4.3.2 Corporate vision, mission, philosophy & objective............................................................... 42 4.3.3 The company organization and business partner ................................................................ 43 4.3.3.1 Resources ............................................................................................................................ 43 4.3.3.2 Management policy .............................................................................................................. 44 4.3.3.3 Medical treatment................................................................................................................. 45 4.3.3.4 Medical tourism services...................................................................................................... 45 4.3.3.5 Supporting services.............................................................................................................. 46 4.3.4 RelaxU medical care ............................................................................................................ 48 4.4 The results of survey research ................................................................................................. 49 4.4.1 General information of the respondents............................................................................... 49 4.4.2 Opinions about Thailand ...................................................................................................... 51 4.4.3 Opinions in medical service in Sweden .............................................................................. 51 4.4.4 Service packages for medical tourism ................................................................................. 54 4.4.4.1 Sources of information on traveling abroad ......................................................................... 55 4.4.4.2 The important factors in a medical treatment....................................................................... 56 4.4.4.3 Supporting services of medical treatment............................................................................ 58 4.4.4.4 Interest in medical treatment................................................................................................ 58 4.4.5 The results of survey research in brief ................................................................................. 60 5 Analysis ........................................................................................................................................ 61 5.1 Situational analysis................................................................................................................... 61 5.1.1 Strategic context and marketing audit.................................................................................. 61 5.1.1.1 External audit ....................................................................................................................... 61 5.1.1.2 Internal audit ....................................................................................................................... 62 5.1.2 SWOT analysis .................................................................................................................... 63 5.1.2.1 Internal analysis of Bangkok Hospital Phuket...................................................................... 63 5.1.2.2 External analysis of Bangkok Hospital Phuket..................................................................... 65 5.2 Strategic tourism marketing planning ....................................................................................... 67 5.2.1 Choosing the generic strategy ............................................................................................. 67 5.2.2 Market STP .......................................................................................................................... 67 5.2.2.1 Market segmentation............................................................................................................ 67 5.2.2.2 Targeting .............................................................................................................................. 68 5.2.2.3 Positioning............................................................................................................................ 69 5.3 Strategic tourism marketing implementation and control ......................................................... 69 5.3.1 Product ................................................................................................................................. 69 5.3.2 Price ..................................................................................................................................... 70 5.3.3 Place .................................................................................................................................... 72 5.3.4 Promotion ............................................................................................................................. 72 5.3.5 People .................................................................................................................................. 74 5.3.6 Process ................................................................................................................................ 74 5.3.7 Physical evidences............................................................................................................... 75 5.3.8 Partnership ........................................................................................................................... 76 6 Conclusion & Recommendation ................................................................................................ 77 6.1 Conclusion................................................................................................................................ 77 6.2 Recommendations.................................................................................................................... 79 6.2.1 Recommendations for the hospital ...................................................................................... 79 6.2.2 Further research................................................................................................................... 80 References List...................................................................................................................................... 81

Sun, sand, surf and surgery in Thailand v

Appendices.............................................................................................................................................. a Appendix 1 Information of Bangkok Hospital Phuket ....................................................................... a Appendix 2 Questionnaires .............................................................................................................. d Appendix 3 Interview questions..........................................................................................................i Appendix 4 Interviewees’ list ..............................................................................................................l Appendix 5 The survey results ........................................................................................................ m

Sun, sand, surf and surgery in Thailand vi

List of figures Figure 1 Research model ........................................................................................................................ 6

Figure 2 The tourism model................................................................................................................... 15

Figure 3 The collaborative strategic tourism marketing planning process ............................................ 16

Figure 4 Market position framework ...................................................................................................... 17

Figure 5 Bases of segmentation............................................................................................................ 18

Figure 6 SWOT analysis framework and SWOT matrix........................................................................ 20

Figure 7 Factors influencing the price of the tourism product ............................................................... 22

Figure 8 Tourism marketing model....................................................................................................... 25

Figure 9 Competitive advantage: Thailand & Asian competitors .......................................................... 30

Figure 10 An overview of medical tourism ............................................................................................ 31

Figure 11 Indicated the medical and healthcare staff and medical staff to population in 2005 ............ 31

Figure 12 Supply chain of international patient ..................................................................................... 33

Figure 13 Waiting times at Swedish hospital......................................................................................... 39

Figure 14 The purpose of visits 2004, ................................................................................................... 40

Figure 15 Swedish expenditures 2004: travel with overnight stays ...................................................... 41

Figure 16 General Information of the respondents (400 persons) ........................................................ 50

Figure 17 Favorite destination............................................................................................................... 51

Figure 18 Rating of a general service and waiting line provide by the local hospitals.......................... 52

Figure 19 Healthcare abroad considerations and worry of waiting for admission................................. 53

Figure 20 The first three ranks of the sources of information................................................................ 55

Figure 21 The important factors in a medical treatment........................................................................ 57

Figure 22 The supporting services before and after treatment ............................................................. 58

Figure 23 Mean of interest in medical treatment ................................................................................... 59

Figure 24 The summary of survey results ............................................................................................. 60

Figure 25 Strengths and weaknesses of Bangkok Hospital Phuket...................................................... 63

Figure 26 Opportunities and threats of Bangkok Hospital Phuket ........................................................ 65

List of tables Table 1 Thailand’s exchange rate until the first quarter of 2006 ........................................................... 27

Table 2 The disposable income per consumption unit for individuals by age....................................... 35

Table 3 Summary of population statistics 1960 – 2005 ........................................................................ 36

Table 4 Patients on the waiting list on April 30, 2002 ........................................................................... 37

Table 5 Age and gender of the respondents (400 persons).................................................................. 50

Table 6 Opinions about Thailand .......................................................................................................... 51

Table 7 Opinions in a medical service................................................................................................... 52

Table 8 Opinions in the waiting line....................................................................................................... 53

Table 9 The worry about a long waiting times to get admission in the hospital ................................... 54

Table 10 The sources of information for choosing the destination, ...................................................... 55

Table 11 The sources of information for choosing the destination, ...................................................... 56

Table 12 The concerning in attractive and reasonable price between ages......................................... 57

Table 13 The concern for an attractive and reasonable price in each occupation................................ 57

Table 14 Mean of interest in medical treatment in case of people who would like to visit Thailand and people who have been in Thailand ........................................................................................ 59

Table 15 Marital status of the respondents ............................................................................................ m

Table 16 Occupation of the respondents ............................................................................................... m

Table 17 Educational background of the respondents........................................................................... m

Table 18 Number of children younger than 18 living in the household .................................................. m

Table 19 The favorite destination in Thailand ........................................................................................ m

Table 20 Healthcare abroad consideration and worry of waiting for admission..................................... m

Table 21 Opinions in healthcare abroad ................................................................................................. n

Table 22 The sources of information for choosing the destination ......................................................... n

Table 23 The sources of information for choosing the destination in each age reange ......................... o

Table 24 The important factors to receive a medical treatment .............................................................. p

Table 25 The supporting services before and after treatment ................................................................ p

Table 26 The supporting services before and after treatment in case of different age groups............... q

Table 27 The supporting services before and after treatment in case of different occupations .............. r Table 28 The supporting services before and after treatment .................................................................s

Table 29 Mean of interest in the medical treatments ...............................................................................s

Sun, sand, surf and surgery in Thailand vii

List of Abbreviations and Definitions

Abbreviations Definitions

Medical Science

4D ultrasound Four-Dimensional ultrasound

CT-scan Computed Tomography Scan

FPL Fluorescent Pulsed Light

HBO Hyperbaric oxygen

LASIK Laser-Assisted In Situ Keratomileusis

MRI Magnetic Resonance Imaging

PCR Polymerase Chain Reaction

General

BGH Bangkok General Hospitals

Fam trip Familiarization and site inspection trip

GDP Gross Domestic Product

GNP Gross National Product

IMC The International Medical Center

ISO International Organization for Standardization

JCIA Joint Commission International United States of America

JCAHO Joint Commission for the Accreditation of Health care Organization

OECD Organization for Economic Cooperation and Development

SEK Swedish Krona

THB Thai Baht

TAT Tourism Authority of Thailand

WTO World Tourism Organization


1 Introduction

International travel for health purposes is becoming a way of life for many countries. A form of vacationing that provides health and medical care services is defined as ‘Medical tourism’ and has become the latest trend in the tourism industry. Thailand has a good reputation as a tourist haven, with a variety of existing tourist attractions, relatively low cost of living and friendly locals (Teh & Chu 2005); at this time, the Royal Thai government is actively promoting this new segment of the tourism industry. Bangkok Hospital Phuket is one of a number of the private hospitals in Thailand, which provides a service package for medical tourists. Its good location in the peaceful tourist location of Phuket province makes it an attractive place for patients to recuperate (Bangkok Hospital Phuket, 2005a).

1.1 Background

There are a number of reasons for the recent boom in the medical tourism sector. Firstly, the high cost of medical treatment, for which people in some countries lack insurance coverage. Secondly, a shortage of doctors and hospital beds in countries in which the healthcare system is supposed to ensure free treatment to all their citizens. Finally, a poor medical infrastructure in some under developed nations. Medical tourist clusters can be divided into four major groups: Americans, the British, patients from the Middle East, and patients from developing countries (Acharyulu & Reddy 2004).

Thailand has a warm weather and beautiful nature for foreign patients who want to enjoy their vacation and have their medical treatment during their vacation time. The Royal Thai Government has tried to encourage the notion that Thailand become ' The Health Tourism Hub of Asia'. The destinations targeted by the government are Bangkok, Chiang Mai, Phuket and Koh Samui. These areas are positioned as Quality Destinations in the delivery of superior medical and health-related services with the core products offered being, for instance, medical care, dental care, and medical check-ups (Aungkasuvapala n.d.).

Although Swedish people are not the major medical travelers, they are the major tourism group in southern part of Thailand. Thailand and Sweden have signed an action plan for the promotion of bilateral relations in all areas and dimensions. The Thai and Swedish governments have also discussed plans to boost the number of Swedish tourist arrivals in the Thai kingdom after the tsunami disaster in late 2004. Thailand now targets long-stay foreign tourists, including those from Sweden, and aims to promote the kingdom as a regional medical hub for foreign visitors as well (Thailand-

Sweden agrees on promoting bilateral relations 2006). This could be a good opportunity for Bangkok Hospital Phuket, a member of the Bangkok Hospital group, which is the biggest healthcare group provider in South-East Asia (Bangkok Hospital Phuket 2005), to offer its health and medical care packages to Swedish tourists.

1.2 Problem identification

Our main research problem is “How can Thai private hospitals increase the number of medical tourists

from Sweden?”


In order to interpret and analyze this main research problem properly, we need to divide this main

problem into the following four sub-problem areas.

- How great is the demand from the Swedish people for medical tourism in Thailand?

- What are the opportunities and threats for the medical tourism industry in Thailand in case of

Bangkok Hospital Phuket?

- What is the potential of Bangkok Hospital Phuket?

- What should be the suitable health and medical care package, the necessary facilitating and

supporting services, for the Swedish medical tourists?

1.3 Purpose

The aim of this study is to analyze the potential for private hospitals in Thailand from a medical tourism

perspective. We also want to study the demand of Swedish medical tourists and to suggest a suitable

health and medial care package with tourism for this market.

1.4 Target group

The target group for our thesis is the Bangkok Hospital Phuket and other hospitals in Thailand that are

interested in medical tourism. We hope our paper would be useful for all stakeholders, who are

involved with the medical tourism industry, for instance, the Tourism Authority of Thailand, The

Ministry of Public Health, hotels and resorts businesses, airline corporations, travel agencies,

insurance companies, overseas hospital, and foreign medical tourists.

1.5 Disposition

The research is structured in six chapters. The first chapter is the introductory chapter, which includes

a background of the area of study, problem identification, purpose, and the scope of this study. Then,

the methodology is provided to describe how the research has been done. The theoretical framework

is discussed in the third chapter in which we describe the models and conceptual frameworks used in

our paper. Next, the empirical findings, where all valid and relevant information was collected, are

offered. This is followed by the analysis chapter, in which we examine the information based on

chosen theories and the findings. Finally, we represent the conclusions that relate to all of the

chapters and make relevant recommendations. Some suggestions of further research are also made.

1.6 Delimitation

This research focuses on medical tourism for the Swedish tourists. Although Bangkok Hospital Phuket

provides a number of services for its patients, our research will study only health and medical care

packaged with tourism that it provides to foreign patients.


2 Methodology

We believe that developing a good process for doing our thesis enables us to answer our research

problems correctly. In this chapter, we attempt to determine the proper research procedure and

explain in detail how the paper is developed, including topic selection, literature study, research

method, and research model. The methodology chapter also describes, how we develop the

theoretical framework and collect data, how reliable the report is and what criticisms of our method

could be.

2.1 Topic selection

Medical tourism is a hot issue in Thailand since that country is poised to become one of Southeast

Asia’s leading healthcare hubs (Fielding & Madden 2005). We are interested in this topic but

developing a program for Swedish tourists is challenging since Sweden is ranked as one of the world's

leading nations in healthcare, technology and facilities (Swecare foundation 2006a). We consulted our

tutor and received informal information, which suggested that Swedish patients endure long waiting

times for medical treatment in Sweden. This information influenced us to search for more evidence

before making a decision about our topic. We were attracted by a dissertation from the Sahlgrenska

Academy at Göteborg University in Sweden, which shows that 1.3 percent of patients die while waiting

for a bypass operation (Swedish Research Council 2005). In our opinion, nobody should die while

waiting for such an important treatment. Thus, we have decided to study the demand of medical

treatments abroad in this market and to select as our topic: “Sun, sand, surf and surgery in Thailand”.

Finally, we made contact with a number of private hospitals in Thailand, which might be interested in

this market. Bangkok Hospital Phuket responded positively to our request and the case study

information presented in this paper stems from its cooperation.

2.2 Literature review

After selecting our research topic, we reviewed the literature to find earlier studies that are relevant to

our research area. The key words in our research were medical tourism and Swedish healthcare

system. Unfortunately, we have not found any papers, which performed studies in the same way that

we will do. A number of previous studies are available which discuss the phenomenon of medical

treatment transfer between countries, but not with a marketing perspective. We retained all useful

papers and listed them in the literature review, categorized into three themes; conceptual framework,

medical tourism and the Swedish healthcare system. Managing this information can help us stay

organized while we are writing our thesis. The details of how we performed our search will be

illustrated in the topic of collecting information.


2.3 Choosing the research methods

According to the Center for Organization, Leadership, and Management Research n.d., qualitative

research is characterized by an emphasis on describing, understanding, and explaining complex

phenomena. The focus is on understanding the full multi-dimensional, dynamic picture of the subject

of study. Its approaches contrast with quantitative methods that aim to divide phenomena into

manageable, clearly defined pieces, or variables.

Due to time constraints, which reduced our ability of doing quantitative research for the whole paper,

we aim to use qualitative methods for data collection and analysis. However, during our literature

study, we could not find any information regarding the demand for Thai medical tourism amongst

Swedish tourists. We therefore had to gather this information from primary sources. After discussion,

it became apparent that the language barrier between the researchers and the Swedish public could

adversely affect the results from face-to-face interviews. Thus, we decided to use a survey to gather

information from the Swedish people and their demand for medical tourism. Our thesis is based on a

combination of both qualitative and quantitative research.

2.4 Research model

To make a clear view of how we did the research, we have drawn up a research model that can be

found in Figure 1, which clearly illustrates our research methods. This begins with a discussion stage

in which we selected the topic area, determined the research problems and purpose. After that, we

searched for a theoretical framework that could help us to answer our research statement and decided

on the methodology to be used. In the findings stage, we interpreted information from both the

primary and secondary data before writing up the empirical section. Next, we analyzed three key

variables, the medical tourism industry in Thailand, Swedish tourists, and the Bangkok Hospital

Phuket through the collaborative strategic tourism marketing planning process, which forms our

conceptual framework. The research model contains loops back to the previous stages where if we

face some problems such as an unsuitable framework or inadequate information and so on. In this

way, we can make adjustments until we finish the analysis part. Lastly, we drew conclusions from our

research results, provided recommendations to our target group, the Bangkok Hospital Phuket, and

suggest further study.


Figure 1 Research model

Source: Authors’ model

2.5 Developing the theoretical framework

We have gathered our information by using an Integrated Model of Tourism (Cook, Yale & Marqua

2002, p.7) as a guideline. We decided to adapt and use an existing specific model that we found from

Tourism marketing: a collaborative approach by Fyall & Garrod (2005), entitled “The Collaborative

Strategic Tourism Marketing Planning Process” as a major framework. Other concepts related to this

model have also been applied, for instance, SWOT analysis, and the eight Ps marketing mix.

2.6 Collecting information

As illustrated in the research model, data collection in this paper was categorized into two sources,

primary and secondary. The data gathered has been used in two major parts of this paper; the

theoretical framework, which was retrieved from secondary data, and the empirical findings chapter, in

which both primary and secondary sources were used.

2.6.1 Primary data

There is a great variety of ways to carry out the primary research methods such as interviews, panels,

questionnaires, observations, documentaries and so on (Fisher 2004, pp.132-133). After reviewing

our research purposes, we have divided the primary data collection into three parts, the potential of

Bangkok Hospital Phuket, medical tourism promotion policy in Thailand and the demand for medical

tourism to Thailand amongst Swedish people. We have selected interviews and questionnaires as our

methods for data collection.

Finding stage

Discussion stage

• Topic area discussion

• Research questions and purposes

• Theoretical framework

• Methodology

• Secondary sources

• Interviews

• Questionnaires

• Data processing of survey

Em

piric

al fi

ndin

g

Analysis Stage

• Analyze what we find through the collaborative strategic tourism marketing planning process

Co

ncl

usi

on

&

Rec

om

men

dat

ion


2.6.1.1 Interviews

We have been in telephone and internet communication with Police Colonel Dr. Sopon

Krisanarungson, Director of The Heart Center, Bangkok Hospital Phuket to ask for permission to carry

out case study research on Bangkok Hospital Phuket. After our request was approved, we e-mailed

the hospital director and the marketing manager to make an appointment for a telephone interview. A

file containing a list of open questions was attached to the e-mail in order to help the interviewees

prepare. We arranged the telephone interview so as to study their policies and performance with

regard to medical tourism. The details of our interview procedure can be found in the appendix 3 and

4.

We also visited the Tourism Authority of Thailand (TAT) in Stockholm to interview the assistant

director, Ms Runjuan Tongrut, and asked her for permission to distribute our questionnaires to

potential Swedish visitors to Thailand. Visiting TAT Stockholm enabled us to gather information

regarding the Thai government’s policy on medical tourism promotion and some information of the

Swedish tourists. In addition, we e-mailed the management of TAT, Stockholm office, to make an

interview appointment and the file of questions was also attached. We arranged telephone interviews

to study their general policies, medical tourism policies and Swedish tourist behavior.

Furthermore, we tried to find more information about the healthcare systems in Sweden and opinions

on medical treatment abroad by interviewing some specialists in the healthcare systems. Fortunately,

Prof Dr. Toni Ivergard, Mahidol University, has kindly given us the information on how to contact

people at the Swedish National Public Health Institute, the Stockholm County Council, and the

International Health, Karolinska Institutet. We conducted the interviews over the internet, and got

response from three specialists as illustrated in the appendix 4.

2.6.1.2 A survey research

The last source of primary data came from a survey, which we examined the potential demand for

medical tourism amongst Swedish people. A process of our survey research is as follow:

� Determining Sample size

Sample size could depend on a size of population, which refers to the larger group from which the

sample is taken and it is what we wish to be able to generalize (Robinson 2004). In this case,

population should not mean all residents of a country since we aimed to survey the demand of people

who are interested in a medical tourism in Thailand. Thus, we have decided to overlook the age under

18 since they do not become sui juris and could not make their own decision in some medical

treatments. In accordance with Statistics Sweden (2006b), the population of Sweden as of December

31, 2005 was 9,047,752 people, consisting of nearly the same number of men as women, and the age

group between 0-17 is 1,934,239 people. Hence, our population size could be 7,113,513. According to

Fisher (2004, pp.159-160), ‘the size of sample depends in part on the size of the margin of error we


are prepare to accept and the size of population, which is a population size Sweden in this case. If the

population is between one million to ten million, the sample size should be 384 to achieve a 95

percent level of certainty’. Therefore, after determining the sample size, we decided to distribute 400

questionnaires.

� Selecting sampling frame

Selecting a sampling frame, a researcher needs a list of names and address of all the people in the

appropriate population (Fisher 2004, p.159). However, it was impossible for us to collect this

information due to time constraint, and almost of this information was provided in Swedish language.

We selected our sampling frame by using accidental sampling. Generally, accidental sampling is not

representative of the target population because sample units are only selected if they can be

accessed easily and conveniently (Statistics Canada 2006) but, no sample will mimic the population

exactly (Robinson 2004). Hence, accidental sampling was a suitable method for this research.

� Designing a questionnaire

The pre-coded questionnaire was designed to collect the data of the Swedes’ demand for a medical

tourism in Thailand. Designing a questionnaire, we aimed to ensure it would cover all the information

we needed, first time, since it would be impossible to collect this kind of information again while writing

the thesis. According to Ford (2004, p. 161) creating questionnaire, two of four sides of A4 paper

would be good. Thus, we tried to keep it as short and clear as possible. In addition, the questionnaire

was designed in two pages and divided into four parts.

• General information: This part we conducted multiple choices questions to gather

demographic background of respondents, such as age, gender, maritime status,

occupation, and so on. We decided to add the age below 18 as one choice of age, we

though that it was not polite to ask about people’s age and leave them. However, this

information still show in the finding part but we omitted them when we did the analysis

part. According to the suggestions of Ms Runjuan Tongrut, the Swedish people would not

appreciate to inform their incomes (R Tongrat 2006, pers. comm., April 18). Avoiding such

question of incomes our tutor suggested us to add a question of the number of children

younger than 18 living in the household, which would useful for evaluating their income.

• Opinions about Thailand: This topic was written to collect the information from people who

know Thailand. Four choices of favorite destination (Bangkok, Chiengmai, Phuket, and

Koh Samui) were study as the target destinations of Health Tourism Hub of Asia.

Question type of this part is multiple choices as well.

• Medical service in Sweden: This part of questionnaire aimed to gather the Swedes’

perceptions about the services provided at local hospitals in Sweden. A one-to-five rating

scale of Likert scale-measurement of attitude (Trochim 2002), was selected in a form of

multiple choice for the better relevance.


• Service package of medical tourism: In this part, we focused on collecting the Swedes’

opinions in the area of service package of medical tourism as well as sources of

information they searched to travel abroad. Question types including a rank order and

Likert scales were employed.

The first draft of questionnaire was sent to Dr. Kongkiat Kespechara, the hospital director of the

Bangkok Hospital Phuket for checking the content validity since Bangkok hospital Phuket is a target

user of our paper. After that, the construct validity of questionnaire was checked by Dr. Leechai

Panyawongngam, a researcher and approved thesis reader at Rajamangala University of Technology

Bangkok, Thailand. The approved questionnaire was translated into Swedish to ensure that the

respondents could understand them clearly due to some technical terms of medical treatments, which

are hard to understand. Furthermore, we did a pretest of questionnaires before distributing them.

� Distrubituing questionnaires

For the convenience of data collection, we prepared questionnaires both in English and in Swedish.

We selected Stockholm and Västerås to be our fieldwork. The questionnaires were distributed and

collected back during April 26 to May 2, 2006. Before handing out, we asked the respondents to

ensure that they are Swedes, know about Thailand, and let them choose either English copy or

Swedish copy to fill up the form. In case of the pensioners, who cannot speak English well, we hired a

Thai student who lives in Västerås to ask for cooperation in Swedish.

April 26, 2006, we started our fieldwork at Västerås Centrum. The questionnaires were distributed at

Mälardalen University, Västerås Centrum and Central station in Västerås during the first three days.

April 29, 2006, we began to do a survey in Stockholm city. It was harder to collect information than in

Västerås since people were not much cooperative and a number of people we asked could not help us

in view of the fact that they were not Swedes. The survey was conducted in Stockholm for four days.

The questionnaires were distributed at Stockholm Centrum, TAT Stockholm, Stockholm Central

Station, Arlanda airport, and Kista Centrum. In addition, some questionnaires were handed out in a

train when we were traveling between these two cities. We discovered that when people stayed still in

the train, we could get much more cooperation.

� Processing data

In data processing stage, we coded each question, verified the dependent and independent variables,

and determined cross-tabulation between some variables.

The completeness of questionnaires was ensured by checking before running a number to avoid some

mistakes. We encoded the raw data with Excel program by the assistant of Khurram Anwar Malik, a

master student of Computer Science and Electronics department, Mälardalen University. The Excel

file (see appendix 2) was sent to be computed through SPSS program under the cooperation of Ms


Tatiya Ongsiriporn of the Information System Department, Rajamangala University of Technology

Krungthep, Thailand.

2.6.2 Secondary data

Secondary data were gathered from textbooks, journals, and research reports and academic articles

available in Mälardalen University’s online library such as Elin@Malardalen and ABI/inform, and public

websites. The key words used to search for the academic articles were “tourism marketing“, “medical

tourism”, “Swedish healthcare system”, “ medical tourism, Thailand”, "waiting line, Sweden", and

“population ’Sweden’”. Several search engines used in data exploration includes Google, Google

Scholar, Yahoo, and Yahoo finance. Other Meta search engines including Mamma

(http://www.mamma.com), Metacrawer (http://www.metacrawler.com) were used to ensure sufficient,

quality information. While searching for information from Thailand, we used http://www.google.co.th to

ensure results specific to Thai web pages. The key words used to search for information pertinent to

Thai web pages were “medical tourism”, “healthcare hub”, “medical tourism, Phuket”, “Bangkok

hospital Phuket”, “Phuket Attraction”. In searching the web pages from Thailand, we applied both Thai

and English language keywords.

Some specific information regarding Bangkok Hospital Phuket was sent to us by conventional postal

mail. The Tourism Authority of Thailand (Stockholm) kindly provided the Statistical Report 2004 on

CD, which contains information and statistics regarding inbound tourists to Thailand.

The collection of information and data for this paper was carried out between 18 January 2006 and 10

June 2006.

2.7 Validity and reliability

According to Henrichsen, Smith & Baker (1997) controlling all possible factors that threaten the

research's validity is a primary responsibility of every good researcher. Validity and reliability are one

of our main concerns since it makes credibility to our paper.

2.7.1 Primary data

To ensure that information from the interviews was credible and complete, we conducted the

interviews with a prepared script. Furthermore, all interviewees were skilled in our field study and

almost all of them have management positions. Questions were always sent to the interviewees at the

time of making the interview appointment to ensure that they had adequate time to prepare their

answers.

We concerned that the quantitative researcher has to check the reliability and validity of both the

questionnaire and research results. The construct validity of our questionnaire was checked by Dr.


Leechai Panyawongngam, as mentioned previously. The content validity of questionnaire was

checked by the director of Bangkok Hospital Phuket. Additionally we asked our adviser to review the

questionnaire in both the English and Swedish versions again before using it. To ensure the

consistency and stability of our questionnaire, we pre-tested it before distribute to the actual

respondents. The consistency of survey results was also based on sampling frame; we have

determined the sample size for a 95 percent level of certainty as mentioned previously. Before

handing out the questionnaires, respondents were screen by initial questions to make sure that they

are Swedes who know about Thailand. Only completeness questionnaires were encoded.

2.7.2 Secondary data

To ensure the validity and reliability of the information, we not only compared the same information

from various sources, but also gave priority to the secondary data gathered from different types of

sources and between different date ranges.

The information provided by governmental sectors has priority over the other sources, as it is official

and must have been reviewed and approved before being published. The country’s information has

been retrieved from the governmental websites of the country we searched and from other reliable

countries. Additional data were sourced from the company documents, journals, the trade press,

newspapers and so on. These sources were less formal than those of the government sectors and we

had to take into account the possible adjustments that companies may have made in order to show

more impressive figures to investors and shareholders. Thus, this kind of information has to be

evaluated and confirmed with interviewees before being used.

Academic papers, for example, dissertations, and academic articles, are the first type of information

that we have selected. Our second level of information came from survey reports from well-known

companies such as AC Nielsen and Kasikorn Research Center in Thailand. News and other non-

academic articles were the last choice due to insufficient references.

We have also given highest priority to the most up-to-date information from sources and types that we

have mentioned. The latest information retrieval date was June 10, 2006. However, as economic

figures need to be accurate, we decided to use government information that may not have been recent

in order to ensure the high validity and reliability of the paper.

The information of how we determined and evaluated the consistency of primary and secondary data

implies that our thesis has adequate reliability and validity.

2.8 Criticism of the method

Since medical tourism is a niche market within the tourism industry, there were not many academic

papers available regarding to the marketing perspective. This may cause literacy criticism of the


research. We concerned that a good sample must be representative of the whole population, however,

we delimited our fieldwork in two cities of Sweden according to time constraints. To evaluate serious

problems in the Swedish healthcare system, it would have been best to conduct in-dept interviews

with doctors and patients at the hospital. However, we could not gather information from this group of

respondents due to the limited time. These could be a criticism of the methods used in our thesis.


3 Theoretical Frameworks

This part describes the theories adopted in our research. Firstly, we retrieve some definitions of

medical tourism to ensure a clear view of our paper. Next, we reference some theories and concepts

from books and some related academic articles. We applied them in the analysis part. Since the aim

of this study is to analyze the potential of private hospitals in Thailand from a medical tourism

perspective, we decide to apply the Collaborative Strategic Tourism marketing planning process from

the book, Tourism marketing: a collaborative approach, by Fyall & Garrod(2005) to be a framework for

discovery and analysis. However, there are three stages in the collaborative strategic tourism

marketing planning process; situational analysis, strategic tourism marketing and planning, and

strategic tourism marketing implementation and control. We follow these three stages but select only

the concepts that are related to our research and omit some sub stages of this theory. First, we use

an Integrated Model of Tourism from the book entitled Tourism: The business of travel by Cook, Yale

& Marqua to find the business environment or the marketing audit in the aspect of collaborative

marketing. Next, SWOT analysis is applied for the situational analysis stage. Then, we do the

marketing strategy formulation and planning. Segmenting, targeting and positioning should occur in

this part. Lastly, we adapt the eight Ps on the stage of strategic tourism marketing implementation and

control. These theories are summarized, to make things clear before proceeding, as follows:

3.1 Definition of medical tourism

Medical tourism is a relatively new term to describe a growing number of people worldwide, who travel

abroad for healthcare. There are an insufficient number of dissertations about medical tourism and its

definition in academic terms. Thus, we obtain the definitions of medical tourism from the Web and

extract some meanings from the academic papers.

Wikipedia (2006a) describes that: “Medical tourism is the act of traveling to other countries to obtain

medical, dental, and surgical care. A combination of many factors has lead to the recent increase in

popularity of medical tourism: exorbitant costs of healthcare in industrialized nations, ease and

affordability of international travel, favorable currency exchange rates in the global economy, rapidly

improving technology and standards of care in many countries of the world”.

Medical tourism is the practice to visit countries with low prices and buy services in their private

hospitals (explanationguide.com 2006)

Medical tourism is defined by Hospital de Marbellar 2006 as “the term for people who travel to other

countries to obtain quality medical, dental and surgical care while at the same time relaxing on

holiday, and fully experiencing the countries they are visiting”

Planet Hospital (2006), quotes that “Medical tourism is the concept of going to another country for

medical, dental, or cosmetic treatment. There are several reasons why patients are gravitating


towards this type of service and they include: lower cost for better care, immediate availability, and

unavailable treatments”

According to Eapen (2005), Medical tourism can be broadly defined as provision of cost-effective

private medical care in collaboration with the tourism industry for patients needing surgical and other

forms of specialized treatment. This process is being facilitated by the corporate sector involved in

medical care as well as the tourism industry- both private and public.

Cook et al. (2005, p.4) explain that medical tourism is the idea of combining medical treatment with a

holiday. It is becoming increasingly fuzzy around the edges, precisely because medical treatment is

merging into the tourist experience, and also because it is sometimes hard to see the boundary

between body modification and medical treatment. Bogg gives details that the term of ‘medical

tourism’ is dubious, can be understood in several ways. It is a fact that many people go abroad for

better access to treatment, for options in treatment or for lower costs of care. It is a good thing to have

the possibility if services at home are inadequate (L Bogg 2006, pers. comm., May 3)

In our opinion, there are some essential concepts to define the medical tourism. First, the destination

should be a foreign country. In contrast to healthcare tourism activities such as spas, sport, and so on

that can provide for both local and international tourists, the medical tourism is specifically aimed to

serve for international tourists. It is a fact that, the medical tourism arises from the demand for medical

treatments that are not immediately available in some ’home’ countries, therefore, the phenomenon of

patients traveling to receive those medical treatment in other country occurs. Second, medical

tourists who travel abroad can be divided into two types; the leisure tourist who incorporates a visit to

the doctor for some minor treatment, as part of his or her vacation, and the tourist traveling specifically

for medical treatment.

3.2 The tourism model

A tourism model was developed to highlight important participants and forces that shape the tourism

industry. It helps the tourist business to capture the dynamic and interrelated nature of tourism

activities. The model consists of four layers, starting with the travelers, which are located in the centre

of the tourism model. The next level is the tourist promoters, who provide the information and

marketing services. Moreover, the individual tourists may interact directly with the tourism service

suppliers who provide the services that are required by tourists; for example, transportation, and

accommodations as in the third layer from the middle in the figure. Finally, all of the participants

individually or as a group, are constantly responding to a variety of social or cultural, political,

environmental, economic, and technology forces (Cook, Yale & Marqua 2002, p.7)


Figure 2 The tourism model

Source: Cook, RA, Yale, LJ & Marqua, JJ 2002 Tourism: the Business of Travel p.7

According to the factors in the tourism model, the travelers are the focal point for all tourism activities

from the centre of the model. Second, the tourism promoters in the next layer include travel agencies,

and tourism board, tour operators, tourist boards, direct marketing, meeting planners and travel

agents. Tourists usually have to make contact with level two members when they are in the process of

planning their vacations. The tourism promoters would search out appropriate choices to meet a

tourist’s needs, rather than spending time and money contacting each supplier.

Next, the tourism services suppliers in the next layer are providers; this layer includes; destinations,

attractions and entertainment, transportation, food and beverages and accommodations. The tourism

suppliers may provide these services independently in competition with each other or in conjunction

with other suppliers. For instance, airline, bus, railroad, cruise ship, and car rental companies may

compete for a traveler’s business. However, tourism services suppliers may often work together to

develop promotional packages designed to encourage tourists to destinations.

Finally, the external environment is in the outer layer. It consists of society, the environment,

technology, politics, and economy. The tourism business does not operate alone; therefore, all of the

members either independently or as a group, are regularly responding to a variety of social, cultural,

political, environmental, economic, and technological factors.


3.3 The collaborative strategic tourism marketing planning process

The collaborative strategic tourism marketing planning process consists of the three key stages; the

situational analysis, strategic tourism marketing planning, and strategic tourism marketing

implementation and control (Fyall & Garrod 2005, p.323).

Figure 3 The collaborative strategic tourism marketing planning process

Source: Adapted from Fyall, A & Garrod, B 2005, Tourism marketing: a collaborative approach, p.324

3.3.1 Situational analysis

The purpose of this stage is to identify the key external opportunities and threat facing the

organization, as well as to ascertain the strengths and weakness internal to the organization (Fyall &

Garrod 2005, p. 325). The vision, mission, goals and objectives of the organization should be

Strategic Context

Corporate vision, mission, goals and objectives

Marketing Audit

External Audit

Internal Audit

S W O T

A N A L Y S I S

Marketing Strategy Formulation and

Planning

Generic strategy options • Differentiation • Cost • Focus

Market position • Leader • Challenger • Follower • Niche • Offensive and

defensive strategies

Push or pull approaches to marketing strategy Marketing Objectives • Market

Penetration • Product

development • Market

development • Diversification

Segmentation, Targeting and positioning

Organic ‘Go-

it-alone’ Strategies

Collaboration strategies

Collaboration characteristics Motives for collaboration Collaboration orientation

Other Joint Strategies

Merger or

Acquisition Strategies

Stages of collaboration

Antecedents Problem setting Direction setting Structuring Outcomes

Collaboration

Life Cycle

Pre-partnership Take-off Growth Prime Declaration Communication or ‘After-life’ options

Types of

collaboration

Coverage Form Mode Motive

Choice of

collaboration partners

Individual excellence Importance Interdependence Investment Information Integration Institutionalization Integration

Collaboration Management and Effectiveness

• Partner’s strategic goals should converge while their competitive goals diverse

• The relative size & market power of partner should be modest compared with industry leaders

• Each Partner should believe that it can learn from the others and at the same time limit access to proprietary skills

• The collaborative alliance should be regarded as a relationship rather than a mere exchange

• There should be an overall consensus as to the general mission of the collaborative alliance

Implementing the Tourism Marketing

Mix

Product decisions

Price decisions

Place decisions

Promotion decisions

People decisions

Process decisions

Physical evidence decisions

Partners

Marketing Evaluation, Monitoring and Control

Situational Analysis Strategic Tourism Marketing Planning Strategic Tourism Marketing Implementation and Control


demonstrated as the strategic context. A wider understanding of the external and internal

environments is necessary before selecting corresponding marketing programs. Meanwhile, the

marketing audit should be done to analyze the business environment. In this case, we apply SWOT

analysis, which will be illustrated in the next topic.

3.3.2 Strategic tourism marketing planning

This part we concentrate on marketing strategy formulation and planning; beginning with the generic

strategy options that business should select, after that the STP-segmentation, targeting and

positioning are quoted.

Competitive strategies can be considered into three generics types, overall low-cost leadership by

achieving the lowest costs of production among rivalries, differentiation through achieving superior

performance in an important customer benefit area, and focusing on the needs of one or more small

market segments(Porter, cited in Fyall & Garrod 2005, p. 88). In accordance with Lumsdon (1997),

cost leadership remains a common strategy among major tour operators and travel agency competing

for market share and leadership. Alternatively, and especially among destinations a more common

strategic option is that of differentiation. Focusing involves total immersion in one market segment by

developing strong relationships with existing and potential customers (Lumsdon, cited in Fyall &

Garrod 2005, p. 89).

Figure 4 Market position framework

Source: Fyall, A & Garrod, B 2005, Tourism marketing: a collaborative approach, p. 93


The organization needs to take full consideration of its position in the marketplace, as this will

influence the strategic options it selected. There are four principle categories of market position;

market leader, market challenger, market follower and market niche (Drummond & Encer, cited in

Fyall & Garrod 2005, p. 92). The details of market position framework are shown in Figure 4.

To implement the marketing concept and successfully satisfy customers’ needs, different service

offering are required. The core of strategic marketing planning process is segmentation, targeting, and

positioning. Segmentation is the subdivision of the total market, which clearly defined by a number of

characteristics as illustrated in Figure 4 (Fyall & Garrod 2005, pp. 100-101).

Figure 5 Bases of segmentation

Consumer bases of segmentation Business-to-business Social bases Personal bases Macro bases

• Culture • Age • Organization size • Subculture • Life cycle • Geographic location • Social class • Occupation • End market served • References groups • Industrial sector • Family • Educational attainment Micro bases

• Roles and status • Lifestyle • Choice criteria • Personality • Structure of decision- Psychological bases • Self-concept making unit • Motivation • Household income • Importance of • Perception • Geographic location purchasing • Learning • Type of purchasing • Beliefs and values Behavioural bases organization

• Purchase occasion • Innovation level of • Situational context organization • User benefits • Purchasing strategy • Usage levels • Personal attributes

Source: Fyall, A & Garrod, B 2005, Tourism marketing: a collaborative approach, p. 101

Target marketing is the term used to describe the selection of market segments to be served by the

various elements of the marketing mix (Drummond & Encer, cited in Fyall & Garrod 2005, p. 102). It is

necessary for the organization to compare and contrast the ideal segments to be targeted with the

organization’s overall capability to meet the segmentations’ needs. The tourism marketer needs to

appreciate travel motivations in order to develop appropriate offerings and brand destinations for the

right target markets. According to Middleton (2002, p.111), the main methods of segmentation that

relevant to international travel and tourism markets include; 1) Purpose of travel, 2) Buyer needs,

motivations, and benefits sought, 3) Buyer behaviour/characteristics of product usage, 4)

Demographic, economic, and geographic profile, 5) Psychographic profile, 6) Geodemographic profile

and 7) Price.

According to Kotler (2003, p. 299), there are five patterns of target market selection. The first one is

“single-segment concentration”, through concentrated marketing; the company acquires a strong

knowledge of the segment’s needs and achieves a strong market presence. In addition, the firm has to

specializing its production, distribution, and promotion to be a leader in selected segment. Second, is


“selective specialization”, which is a pattern that the firm selects a number of segments, each

segments objectively attractive and appropriate, and may have less or no involvement to the other.

The third pattern is “product specialization” that the company makes a certain product selling to

several segments. Forth, is “market specialization”, which the company focuses on serving many

needs of a particular customer group. The last pattern is “full market coverage” that the firm attempts

to serve all customer groups with all the products they might need.

Positioning is the final stage in the process. An organization positions itself to meet the expectation of

its customers or potential customers. Positioning can be divided into three key stages, identification of

a set of competitive advantages to choose from differentiation, prioritizing these advantages in order to

select an optimum set, and communicating and delivering the selected position to target segments

(Zafar, cited in Fyall & Garrod 2005, p. 104).

According to Himmelman (1996), Collaboration means exchanging information for mutual benefit and

altering activities, sharing resources, and enhancing capacity of one another for mutual benefit and

achieves a common purpose (Himmelman, cited in Fyall & Garrod 2005, p.154).

However, our paper may have less information to suggest for the appropriate collaboration since a

research aims to study the demand of customers more than business-to-business aspect. Moreover,

tourism industry has a fragmented nature, it comprises with a large number of organizations from a

wide range variety of contexts and with a wide variety of organizational characteristics, including

transport, accommodation, catering, entertainment, retail, insurance and many others (Fyall & Garrod

2005, p.142).

3.3.3 Strategic tourism marketing implementation and control

Since our research aim is to study the Swedish market as a new market of medical tourism package,

we emphasize the implementation of the tourism marketing mix at this stage and ignore the aspect of

control. The main elements of marketing mix are 4Ps which were originally described by McCarthy in

1960; however, to reflect the customer orientation that is the main aim of modern services marketing,

Kotler et al (1999) recast the ‘4Ps’ in to the ‘4Cs‘. Product corresponds to customer value, which is

the perceived benefit provided to meet needs and wants of the customers. Price corresponds to cost

in customers’ facet. Place corresponds to convenience in term of customer access to the service they

buy. Promotion corresponds to all forms of communication (Kotler et al, cited in Fyall & Garrod 2005,

p. 105). According to the collaborative strategic tourism marketing planning process as illustrated in

Figure 3, the extended marketing mix is used in this stage as well. It consists of the other four Ps;

people, process, physical evidence, and partners. In this case, we adopt the ‘8Ps’ as the aspect of

marketing mix for the medical tourism business. The tourism marketing mix will be shown in detail at

the last part of this chapter.


3.4 SWOT analysis

SWOT analysis of Bangkok Hospital Phuket in this case, is in the situational analysis of the

collaborative strategic tourism marketing planning process. The SWOT analysis technique is able to

provide a summary ‘position statement’ of the internal strengths and weaknesses, and external

opportunities and threats to either an organization or a collaborative domain (Fyall & Garrod 2005, p.

337). It serves to highlight a firm’s distinctive competences, which will enable it to gain competitive

advantage (Morison 2002, p.25). A process of SWOT analysis is illustrated in Figure 6.

Figure 6 SWOT analysis framework and SWOT matrix

Source: Quick MBA, Strategic Management 2006

After analyzing the business environment, an organization will earn results of its business situation

from both inside and outside the corporation. However, to develop a business strategy, it has to

construct the SWOT Matrix that can produce four types of strategies (Quick MBA, 2006).

o S-O strategies: These strategies are based on institutional strengths that a business can use

to take advantage of market opportunities.

o W-O strategies: A business gains opportunity but it has weakness inside, then it want to

remove internal weaknesses by taking advantage of external opportunities.

o S-T strategies: An organization has internal strengths to decrease the impact of external

threats.

o W-T strategies: This strategy reduces both internal weaknesses and external threats. So that,

a business has to used the defensive strategies, to diminish its weakness and avoid the

impact from threats.


3.5 The tourism marketing mix

Cooper et al (cited in Fyall & Garrod 2005, p. 105) identified the tourism marketing mix as a set of

controllable tools that may be manipulated to meet specific objectives and attract to a target market.

The marketing mix that is applied to tourism is adopt from the traditional marketing mix, which consists

of four main elements of the marketing mix including product, price, place and promotion, or customer

value, cost , convenience and communication in customers’ aspect as was previously mentioned.

Moreover, the extended marketing mix (people, process, physical evidence and partnership) are

applied to the tourism marketing as well.

3.5.1 Product

Product refers to anything that can offer to a market for attention, acquisition, use or consumption,

which might satisfy a want or need (Kotler et al, cited in Rappel 2003). Instead of product, we apply

the service perspective in this part. As mentioned by Grönroos, service is a process consisting of a

series of intangible activities that normally, but not necessarily always, takes place in interactions

between the customer and service employees and/or physical resources or goods and/or systems of

the service provider, which are provided as solutions to customer problems. Moreover, the

characteristic of the service is intangible, heterogeneous, perishable, and simultaneous (Grönroos

2000 pp.46-47).

The book Service Management and Marketing by Grönroos (2000 p.166) illustrated that in the service

concept, basic service package has been defined as composed by core service, facilitating services

and supporting services. First, core service is the reason for a company being on the market. Second,

facilitating service is the use of the core service and if facilitating services are lacking, the core service

cannot be consumed. The facilitating service is mandatory. Finally, supporting services are used to

increase the value of the service and/or to differentiate the service from those of competitors. If the

supporting service are lacking, the core service can still be used (Grönroos 2000, p.166). Besides

basic service package, augmented service concept combined other three elements, which are

accessibility of the service, interaction with the service organization and customer participation.

Product influences not only the marketing mix but also a company long-term growth. In the context of

tourism destination, the product is said to include the destination’s attractions and its environment, the

destination facilities, and service accessibility to the destination (Fyall & Garrod 2005, p.106)

3.5.2 Price

Price means the amount of money charged for a product or service, or the sum of the values that

consumers exchange for the benefits of having or using the product or service (Kotler et al, cited in

Rappel 2003).


As discussed by Ghauri & Cateora (2005 p.440) the company should decide when to follow a

skimming or a penetration-pricing policy. Traditionally, the decision on which policy to follow depends

on the level of competition, the innovativeness of the product, and market characteristics.

‘Skimming’ as defined by the book of International Marketing by Ghauri & Cateora (2005 p.440) refer

to charging a high price to maximize profit in the early stages of a product’s introduction while

‘penetration pricing’ mean charging lower prices to gain market share in a new market. There are four

different type of pricing strategy including rapid-skimming strategy, slow-skimming strategy, rapid-

penetration strategy and slow penetration strategy. With regard to pricing of the tourism industry,

Figure 7 highlights a number of the key determining variables.

Figure 7 Factors influencing the price of the tourism product

• High fixed operational cost nature of much of the tourism industry, most of which requires high load factors and strict cost control.

• Interrelated and interdependent nature of the pricing of the various elements that constitute the tourism product

• Seasonal demand that leads to peak and low-season periods, which require demand management pricing to cope with short-run capacity problems.

• Near certainty of tactical price cutting by competition whenever supply exceeds demand.

• Long lead times in holiday markets between price decisions and product sales.

• Government involvement in the market

• High vulnerability to demand changes due to volatility of the external macro-environment and currency exchange rate fluctuations.

• Pricing of separate elements of the tourism product, which can have detrimental impacts on the demand for other components of the tourism product, i.e. cost of travel.

• Extent to which tourism product is considered to be a luxury or a necessity and the amount of trips taken in a year.

Source: Adapted from Cooper et al 1998, Lumsdon 1997, McIntosh et al 1995 and Middleton 2001 (cited in Fyall & Garrod 2005, p. 111)

3.5.3 Place

Place means all the company activities that make the product or service available to target customers

(Kotler et al, cited in Rappel 2003).

In the tourism context, Godfrey and Clarke (cited in Fyall & Garrod 2005, p 114) define the “place”

element of the marketing mix as “routes of exchange” through which a tourist accesses, books,

confirms and pays for a tourism product.

In the tourism context, there are two main strategic choices exist. The former is to adopt an intensive,

selective or exclusive distribution strategy regarding outlet types and numbers, while the latter is to

adopt a push or pull strategy. The latter choice is that which is fundamental to all tourism-related

organizations. The distinction between the two is that a push strategy focuses on distribution outlets,


urging them to sell to the tourist, while a pull strategy is directed at generating tourism demand, which

is then sucked through the appropriate distribution outlets (Fyall & Garrod 2005, p.117).

3.5.4 Promotion

Promotion refers to activities that communicate the product or service and its merits to target

customers and persuade them to buy. According to Fyall & Garrod (2005 p.120), the traditional

promotion mix includes public relations, advertising, sales promotions, personal selling, direct

marketing and database marketing. However, the characteristics of services have an important impact

when it comes to the development of communication strategies. Parmer (cited in Fyall & Garrod 2005,

p 119) highlights three concerning points that: Firstly, the intangible nature of the service offer often

results in consumers perceiving a high level of risk in the buying process. Secondly, promotion of the

service offer cannot generally be isolated from promotion of the service provider. Finally, visible

production processes, especially service personnel, become an important element of the promotion

effort. Additionally, the intangible nature of services and the sensitive possibilities for results in their

promotion being generally more constrained by legal and voluntary controls than goods.

3.5.5 People

People refers to all human participants who play a part in service delivery and influence the buyer’s

perception including contact employees, the customer him/herself, and other customers in the service

environment (Bitner & Zeithaml 2003, pp.110-111). As mentioned by Fyall & Garrod (2005 p.121), this

applies to interactions and relationships between visitors or tourists, employees of tourism

organizations and more often than not at the destination level, the host community. Interactions and

relationships between these three key “people” groups will affect significantly the level of product

satisfaction of the employees and the degree to which tourism either accepted or rejected at the host

destination.

3.5.6 Process

Process is the actual procedures, mechanisms, and flow of activities by which the service is delivered,

the service delivery and operating systems; for example, operational flow of activities, steps in the

process, flexibility versus standard, and the technology versus human (Bitner & Zeithaml 2003, p.110-

111). As mentioned by Middleton (cited in Fyall & Garrod 2005 p.122), the tourism experience is more

often than not “highly dependent on the quality of service delivery as perceived by the user”. The

process element is frequently instrumental in the final delivery of the service encounter. Other

essential components of the value chain such as booking systems, payment systems, queue

management and visitor-flow techniques and the area of interpretation are all examples of the process

component of marketing in a tourism context.


3.5.7 Physical evidence

Physical evidence means the environment in which the service is delivered, the place where the firm

and customer interact, and any tangible components that facilitate performance or communication of

the service. These are included the tangible communication, servicescape, guarantees, technology,

and website (Bitner & Zeithaml 2003, p.110-111). Of the many aspects of tourism, the physical

environment is a core component of the tourism product. As said by Middleton (cited in Fyall & Garrod

2005 p.123), due to the intangible nature of tourism products, the physical evidence aspect of the

marketing mix is more often than not used to “tangibilise” the offer away from the place of

consumption “especially at the point of sale, to influence purchasing”.

3.5.8 Partnership

For tourism in particular, Goeldner et al.(cited in Fyall, A & Garrod, B 2005 p.123) recommend that

“partnership” should be added into the marketing mix. The particular combination of the tourism

marketing mix used by any organization needs to offer it a competitive edge or differential advantage

in the market place. The partnership is linked to the wider ideas of collaboration and network

development since the marketing mix in tourism involve some form of collaboration activity.

3.6 Summary of theoretical framework

To sum up what theories applied in our thesis, we draw our own model as illustrated in Figure 8. We

gather information by using the tourism model. This model consists of external environments, tourism

services suppliers, which focus on Bangkok Hospital Phuket, tourism promoters, which concentrate in

Tourism Authority of Thailand, Stockholm office, and travelers who are the Swedish medical tourists.

The analysis process is adapted from the collaborative strategic tourism marketing planning process

by Fyall & Garrod (2005) as mentioned earlier. We do the situational analysis, along with strategic

tourism marketing planning, and implementing tourism marketing mix that are described in Figure 8.


Figure 8 Tourism marketing model

(Summary of all theories used in this paper)

Source: Authors’ model

Situational Analysis

External environment

Tourism services suppliers

Tourism promoters

Tra

vele

rs

Strategic context Corporate vision, mission, goals, and objectives

Marketing audit External & Internal audit

SWOT analysis

Strategic Tourism

Marketing Planning

Generic strategy options

• Differentiation • Cost • Focus

Segmentation

Targeting and

Positioning

Data Collecting Analysis

Strategic Tourism

Marketing Implementation

and Control

Implementing the Tourism Marketing Mix � Product � Price � Place � Promotion � People � Process � Physical evidence � Partners


4 Empirical Finding

This chapter provides the information in four topics. First, the situation of medical tourism in Thailand

is exemplified. Second, we target the Swedish tourists, thus, the information about healthcare system

in Sweden and the Swedish traveling behavior are provided. Next, we give the information of Bangkok

Hospital Phuket, a case study of this paper. Lastly, we illustrate the results of survey research.

However, Thailand is the developing country, and its “Baht” currency may not be familiar. Hence, we

convert the Baht into US dollar by using the fix rate at THB 40 per one dollar. Although it is not exactly

exchange rate, the audiences may have clearer view when reading this paper.

4.1 Medical tourism in Thailand

In this part, we illustrate Thailand by using a tourism model to highlight the important forces that shape

the tourism industry in Thailand, especially the medical tourism.

4.1.1 Thailand in brief

Thailand is located in the heart of the Southeast Asian mainland. Its name in local language is “Prathet

Thai", which means land of the free. The country covers an area of 513,115 square kilometers,

equivalent to the size of France (US Department of State 2005). Thailand borders the Lao People's

Democratic Republic and the Union of Myanmar to the North, the Kingdom of Cambodia and the Gulf

of Thailand to the East, the Union of Myanmar and the Indian Ocean to the West, and Malaysia to the

south (Ministry of Foreign Affairs 2006a).

The country comprises 76 provinces that are further divided into districts, sub-districts and villages.

Bangkok is the capital city and centre of political, commercial, industrial and cultural activities. The

time in Thailand is seven hours ahead of Greenwich Mean Time (Tourism Authority of Thailand

2006a)

4.1.1.1 Economy

Generally, the tourism industry and economy are likely correlated. Economic growth drives the growth

in the tourism sector. On the other hand, tourism encourages growth of the economy through greater

employment and inbound revenue (Klongkumnuankarn 2005). Thailand is a developing country; the

Thai currency is the “Baht”. According to the Bank of Thailand (2006), the average exchange rate in

the first quarter of 2006 is THB 39.3 per one US dollar. The dynamic appreciation of the Thai Baht can

affect the exporter of international service suppliers since the same price in Thai baht will cost more

money in other currencies.


Table 1 Thailand’s exchange rate until the first quarter of 2006

Baht: US$ (Reference rate represented by average inter-bank exchange rate)

Year 2000 2001 2002 2003 2004 2005 2006 q1

Rate 40.2 44.5 43.0 41.5 40.3 40.3 39.3

Sources: Adapted from the Bank of Thailand 2006, Thailand's Key Economic Indicators

In 2005, the Thai economy was affected by surging oil prices and negative domestic factors including

drought, the tsunami disaster, avian influenza, flood and unrest in the three southern provinces. As a

result, the real GDP expanded only 4.5 percent relative to 6.1 percent in 2004 (World Bank Thailand

Office 2006, p.6). GDP growth will recover modestly to 5 percent in 2006 on the back of stronger

export growth, notwithstanding recent developments (Versak 2006).

The tourism sector has been recognized as one of the major sources of foreign revenue for Thailand.

The government forecasts that between 2005 and 2008, revenue from inbound tourism should surge

by 15 percent annually. In other words, such revenue is projected to reach THB 700 billion or around

US$ 17.5 billion in 2008 (Klongkumnuankarn 2005).

4.1.1.2 Politics

According to Cook, Yale & Marqua (2002, p.287), Politics is about decision-making; how decisions are

made, who is involved in the process and how decisions are implemented. The politics of tourism is

usually about how decisions concerning use of scare resources are made. In this part, we discuss the

Thai government policies in which relate to medical tourism in Thailand.

The Cabinet approved a five-year strategic plan for the project of developing Thailand as “Center of

Excellent in Asia”, as proposed by the Ministry of Public Health during its meeting on 29 June 2004

(The Government Public Relations Department 2004). The plan aims to encourage both the public and

private sectors to develop their health service businesses to international standards. The Government

believes that the project will enable Thailand to earn substantial income from medical treatment and

other related services, such as dental care, annual medical check-ups, spa services, traditional Thai

massage, long-term healthcare, food, medicine, and cosmetics. The target areas cover Bangkok,

Phuket, Chiang Mai, and Samui Island in Surat Thani.

The plan consists of three strategies, involving marketing and public relations, management, and the

development of health services and products. First, the marketing and public relations strategy, which

emphasizes international negotiations on health businesses, was launched. Road shows,

familiarization trips, media production, surveys and analysis of customers’ demand, assessment of

customer satisfaction, and the creation of health business’ information network in foreign countries are

also required. The second strategy, concerning management, seeks to establish an organization to

manage strategies and set standards for health services. The regulations should be revised to enable

foreign clients to have easy access to health services in Thailand. The use of a “Fast Track Visa”


system that facilitates the entry of foreigners seeking medical care in Thailand and that requires

cooperation from the Ministry of Foreign Affairs was proposed by the private hospital association.

However, Swedish people can stay in Thailand as a tourist for up to 30 days with out visa (The Royal

Thai Embassy-Stockholm 2006) and a fast track visa is processed the same as a tourist visa, which is

issued for a 60-days trip. The third strategy, for the development of health services and products,

includes research to improve health services and products. It also seeks to develop the quality of

health personnel and laboratories and promote the use and sale of local products (The Government

Public Relations Department 2004).

In the year 2005, ten additional provinces with high potential for the development of health tourism

were incorporated into the plan, including Chiang Rai, Chon Buri, Udon Thani, Krabi, and Songkhla.

Three major areas: medical services, healthcare services and Thai herb products, were points of focus

(The Government Public Relations Department 2006).

On 23 January 2006, Thailand and Sweden signed the Joint Plan of Action between the two countries.

The plan has a strong intention to enhancing cooperation in a wide range of aspects such as trade

and investment, education and human resource development, tourism (especially for long stays),

promotion of Thailand as medical hub, as well as defense and the military to combat international

crimes (Ministry of Foreign Affairs 2006b). This political policy encourages the medical tourism

between Thailand and Sweden as well.

4.1.1.3 Technology

Technological advances are not only enhancing businesses’ efficiency but also providing more

convenience to tourists. Thailand has good infrastructure, improved and modernized transportation

facilities, as well as upgraded communications and IT networks (Thailand board of investment 2006).

The country has been expanding its information service for residents and tourists alike through the

Internet system. Internet services are now available at Thailand's leading hotels and at the many

“Cyber-Cafes” that are cropping up in all major tourist destinations (Tourism Authority of Thailand

2006a).

In case of medical service in Thailand, not only hospital ambulances are available for first-aid

treatment. Helicopters and airplanes can provide for longer distance transport between provinces and

countries within a short period. Patients’ information and records can be swiftly transmitted via satellite

and optical cable wires. The tourists can be assured that their medical records of previous drug

allergies or illnesses will be efficiently transferred by means of these technological advances

(Thongsiri 2003).

The medical and rehabilitation equipments, used in the private hospital sector in Thailand, are 80

percent imported. The main suppliers are USA, which represents 40 percent of the total supply, along

with Japan, Germany and UK (Royal Danish Embassy-Bangkok 2004). The private hospitals are

equipped with modern medical instruments, such as gamma knife technology, MRI scanner, etc.


However, they have less technology in Hi-tech hardware when compare to other Asian competitors,

for instance, Singapore, India and Hong Kong (Bangkok Bank Public Company Limited 2005).

4.1.1.4 Environment

The environment is one of the most important factors that determines the role of tourism activities in

any country. Standards enhancement for service quality as well as environmental conservation is

required in response to demands of tourists (Klongkumnuankarn 2005) In this case we emphasize the

Phuket province since it is the location of Bangkok Hospital Phuket.

Phuket was among the six tsunami-affected provinces on the Andaman Coast in the year 2004.

However, the province has been supported by the World Tourism Organization (WTO) to help it

recover. As far as environmental rehabilitation, Thailand’s Ministry of Natural Resources and

Environment is working with many foreign experts and institutions to restore some parts of the marine

and aquatic environment to affirm that its natural marine beauty in the Andaman Sea will become as

good as it has ever been (The Government Public Relations Department 2005). Meanwhile, Phuket is

returning to normal.

4.1.1.5 Social/ Culture

Thais are well known for their friendliness and hospitality. A large majority of over 62 million citizens of

Thailand are ethic Thai, along with strong communities whose ethnic origins lie in China, India and

elsewhere. The official language is Thai. However, English is widely understood, particularly in

Bangkok. English and some European Languages are spoken in most hotels, shops and restaurants

in major tourist destinations include Phuket (Tourism Authority of Thailand 2006a). There is absolute

religious freedom in Thailand; however, approximately 95 percent of the population is Buddhist. The

religions of the rest of the population are Islam, Christianity, Hinduism, and others (Department of

export promotion 2006). Phuket province has diverse ethnic groups and culture. Approximately 35

percent of the population is comprised of Thai-Muslims (Tourism Authority of Thailand 2006b).

4.1.2 The situation of medical tourism in Thailand

Thailand’s strategy to make the country the center for health services in Asia as mentioned earlier. For

healthcare, the target is to increase the number of foreigners seeking medical treatment in Thailand’s

hospitals to two million by 2010 (Bangkok Bank Public Company Limited 2005). In the year 2005,

nearly 1.3 million foreigners came to Thailand for medical treatment (Thailand’s private hospitals

prepare for major overseas push 2006).

The medical tourism industry in Thailand is set to explode. The sector is expected to grow by a

staggering 66 percent in 2006. Medical visitors can be divided into two categories; the tourist who

comes predominantly for leisure and includes a check-up or a simple procedure, like laser sight

correction (LASIK) or teeth whitening, during his holiday, and the tourist whose destination is the


hospital (Goldstein 2006). However, Thailand is not the only country in the region pushing for medical

tourism. The regional competition has also intensified as Singapore, India, Malaysia and Hong Kong.

Against these competitors, Thailand has an advantage in services, hospitality and reasonable cost of

medical care as illustrated in Figure 9.

Figure 9 Competitive advantage: Thailand & Asian competitors

(X means a degree of competitive advantage)

Source: Association of Thai Private Hospital, cited in Bangkok Bank Public Company Limited 2005, Health Products and Health Services: Another industry in which Thailand is competitive.

Thailand has become increasingly popular for a wide range of procedures, as varied as cosmetic

surgery, dental work, hip and knee replacements, back surgery and more. The main attraction for

'medical tourists' to Thailand is easy access to high-quality medical treatment at bargain prices, and, in

some cases, to treatments that are unavailable in their home countries. The cost of medical treatment

in Thailand is cheaper than its rivals in the region. Thailand also enjoys a major cost advantage over

the United States and Europe with prices as much as five to ten times cheaper(Medical Tourism:

Putting the fun into clinical procedures 2006, p.14). In the opinion of Dr.Lennert Bogg, Karolinska

Instutet, the price of medical tourism package in Thailand is good; however, the quality of treatment is

of concern (L Bogg 2006, pers. comm., May 3).

Moreover, a number of Thai private hospitals look like luxury hotels with modern interior and exterior

designs, and features to make patients feel like they are in a warm atmosphere, which is far different

from hospital surrounding. In addition, some hospitals also provide in-house restaurants and food

courts, spa and fitness facilities. Beyond the impressive features, the standard of the nursing care is

another factor that can be trusted. Today, many Thai private hospitals have already been approved by

the standard of ISO 9000 and the Joint Commission on International Accreditation (Thongsiri 2003).

In the year 2002, private hospitals in Thailand earned US$ 470 million from medical tourism as

illustrated in Figure 10.


Figure 10 An overview of medical tourism

Source: Datta & Krishnan 2003, Global Health Trade: The Health Travelers

In Phuket, there are two international standard hospitals, Bangkok Hospital Phuket and Phuket

International Hospital. Both of these offer reasonably priced private treatment and procedures catering

to international as well as local patients. The Phuket International Hospital offers every specialty of

medicine and surgery, it provides interpretation services in several languages (Phuket International

Hospital 2006a). The hospital’s size is excess 100 beds (Phuket International Hospital 2006b). The

room rates and price of some treatments are also provided on the website in different languages but in

Thai baht (Phuket International Hospital 2006c). Other hospitals in the city include Mission Hospital, a

small private hospital that provides a cheaper alternative to the two large hospitals and Vachira

hospital, the main government hospital on the island (Phuket Health Travel & Tourism 2006). There

are also a number of private clinics specializing in cosmetic surgery or dental care, reaching every

corner of the island (Chaisawat 2006). The medical staff ratio of the city such as doctors, dentists, etc

is higher than the country ratio as illustrated in Figure 11. Meanwhile, this province has been steadily

gaining a reputation as a health tourism destination, with a large range of spas and medical services.

Figure 11 Indicated the medical and healthcare staff and medical staff to population in 2005

Sources: Public Health Changwat Phuket, cited in Chaisawat 2006


4.1.3 Tourism promoters

According to Cook, Yale & Marqua (2002, p. 7), the tourism promoter is the organization that provides

information and other marketing services. The Tourism Authority of Thailand is a formal tourism

promoter. We collected information by interviewing the management of the Tourism Authority of

Thailand, Stockholm office, since we aim to study the Swedish market.

The Tourism Authority of Thailand (TAT) - Stockholm was established on October, 2002, to be a

source of information about Thailand for individuals, travel agents and journalists in the Nordic

countries, the Baltic States and Russia C.I.S. as well as to encourage them to travel in Thailand

(Tourism Authority of Thailand 2006c)

According to Ms Runjuan Tongrut, the assistant director, TAT Stockholm targets every group including

students in the university to promote Thailand (R Tongrat 2006, pers. comm., April 18). Mrs. Veena

Panjamanond Bohlin, the marketing manager, informed us that the winter months are the peak season

for traveling to Thailand from the four Scandinavian markets: Norway, Sweden, Denmark and Finland.

The favorite destinations of Swedish people in her opinion are beaches where they can have sunbathe

such as Phuket, Krabi, Phan-nge, Samui. Holiday package lasting around two weeks and Long-stay

packages are the tourism packages that can encourage this target group. These activities are also

promoted by the Royal Thai government, especially to retirees (V Panjamanond Bohlin 2006, pers.

comm., May 3).

The business network of TAT Stockholm to promote Thailand consists of two groups, the travel trade

and media. The travel trade, for example, travel agencies, tour operators, Airline members in

Scandinavian and Finland, are working together with TAT and can use the TAT website to login for

more information. The TAT Stockholm also promotes Thailand and its activities through the travel

trade and other Media, especially newspapers and magazines, such as Norrland Magazine in

Sweden. TAT Stockholm also works with travel industry counterparts by launching a series of

familiarization and site inspection trips - the FAM trip, designed to restore the confidence of

Scandinavian travel agents, tourism operators and media representatives (V Panjamanond Bohlin

2006, pers. comm., May 3).

In the case of Phuket, TAT Stockholm launched a sustained program of marketing and promotional

activities during the immediate post-tsunami recovery period in early 2005. The areas of attraction are

Phuket, Krabi and other destinations along the Andaman coast. In the year 2005, TAT Stockholm and

Finn Air jointly hosted a ‘fam trip’ to Phuket and Krabi for eight representatives to enable leading travel

and tour operators to gain first-hand information and assess Phuket’s level of readiness to receive and

welcome tourists during the 2005 and 2006 high season(Tourism Authority of Thailand 2006d).

However, there is no specific promotion for medical tourism in Sweden since it is a niche market, like

other types of health tourism, including spas, golf and other sports, etc. According to Mrs. Veena


Panjamanond Bohlin, medical tourism is promoted when TAT Stockholm participates in trade

exhibitions. Suitable packages for Swedish tourists are medical check-up, dental care and eye care

since other medical treatments in this country are supported by the government. At the present time,

no tour operators in Sweden offer any medical tourism packages since it is not popular. Those

tourists whose destination is a hospital would arrange their trips with the assistance of hospital

coordinators (V Panjamanond Bohlin 2006, pers. comm., May 3).

Generally, in order to cooperate with the hospitals in Thailand to promote their services, TAT

Stockholm needs their proposal to review the project before launching mutually promotion. However,

in case of event marketing, the medical tourism providers can feel free to ask for cooperation with TAT

and the Royal Thai Embassy in Stockholm(R Tongrat 2006, pers. comm., April 18)

4.1.4 Tourism service suppliers

In providing the medical tourism for a foreign visitor, not only a hospital but also other service

providers are part of the business network. Figure12 illustrates a supply chain of international

patients.

Figure 12 Supply chain of international patient

Source: Adapted from Acharyulu 2004, “Hospital Logistics Strategy For Medical Tourism”

According to Figure 12, a tourist or a patient in need of medical treatment, who wants to obtain

medical tourism services, has to interact with a number of medical tourism service suppliers, for

example, hospital, transportation, accommodations, destinations and attractions. However, this paper

concentrates on Phuket Island as the destination. We have already discussed the major service

supplier, which is a hospital. In this part, we will illustrate Phuket attractions.

International patient in need of healthcare

Depart, Airport Pick-up, Ride to

the hotel

Planned Hospital Accommodation Hotel / Hospital

Hospital scheduling patient care management pre/post operative care

Tourism plan Recreational/ sight

seeing visits etc

Air ticket booking

Arrive at airport of destination

Information Center in the Country,

Internet

Query

Ministry of health,

Insurance

Patient flow

Information flow

Start

End


Phuket is Thailand's largest island and lies in the Andaman Sea along the country's southwestern

coast. The island is connected to the Thai mainland by a bridge. It is located approximately 862

kilometers south of Bangkok (Tourism Authority of Thailand 2006f). The city has two seasons, from

May through October is the rainy season and the hot season is from November through April. Rain

rarely lasts longer than a few hours in the tropics and the sun soon shows itself again (Pacific Asia

Travel Association 2006). Visitors are recommended not to travel to Phuket between September and

October as they are the wettest months. There are a number of excursions in Phuket, for instance,

water sports, horseback riding, jungle walking, eating out, watching a show, dancing, elephant

trekking, or playing golf. Phuket was named the best travel destination in summer of 2005. It also

earned top score of 93 percent repeat visit destinations from the survey of MyTravel Group. At

present, the island resort has virtually fully recovered following the tsunami (Tourism Authority of

Thailand 2006g).

4.2 Targeting the Swedish market

As mentioned in the introduction chapter, the Swedish tourists are our target group. In this section, we

will give the information about the Swedish market including Sweden in brief, the healthcare situation

in Sweden, and Swedish traveling behavior.

4.2.1 Sweden in brief

The Kingdom of Sweden is a Nordic country, situated in Scandinavia or Northern Europe. The country

was one of the poorest countries in Europe before its development of transportation and

communication. With the developing in the areas, Sweden has been able to utilize its resources

especially timber and iron ore. After the World War II, Sweden took the opportunity that the country

has from its competitive advantages in natural resources to expand its industry to supply and rebuild

Europe, which suffered damaged from the war. The result of the utilization of its resources enabled

Sweden to have economic growth (Wikipedia 2006b).

In 1960, the country became one of the richest countries in the world. Moreover, during the post-war

era, the Swedish Social Democratic Party controlled the country then the establishment of a welfare

state was begun. Under the rule of Swedish Social Democratic Party with a “Well being for all” policy,

the country used its social-liberal tendencies to start on a strong national quest for equality in its

society. The country also ranks at one of the top nations in the UN Human Development Index.

Sweden, despite its officially neutral stance, joined the European Union in 1995, arguing that neutrality

was less important in the post-Cold War world. However, in a 2003 consultative referendum, Swedish

citizens declined to adopt the Euro (Wikipedia 2006b).

For the language usage, Swedish is the principle language of Sweden or the official language in

international contexts. Business language in this country are Swedish and English, that is the most

commonly studied language in Sweden (Lindgren B. n.d.).


4.2.1.1 Economic

Economics is the "social science that seeks to understand the choices people make in using their

scare resources to meet their wants" For tourists, these scare resources are money, available time,

and the physical energy to travel, while having a large amount of these resources will increase tourist

ability to travel (Cook, Yale & Marqua 2002, p 280). In this case, we collect information of the Swedish

economy to evaluate the purchasing power of our target group.

In the year 2004, the statistics from the Organization for Economic Cooperation and Development

(OECD) illustrated that Sweden had the highest tax-to-GDP ratio among OECD countries, at 50.7

percent of gross domestic product, compared to around 49.6 percent in Denmark, followed by Belgium

at 45.6 percent (OECD 2005). With the welfare system such services as tax-funded childcare, parental

leave, a ceiling on healthcare costs, free education (all levels up to, and including university),

retirement pensions, free dental care up to 20 years of age and sick leave (partly paid by the

employer), the country requires taxes at high rate of minimum at 30 percent and additional high-

income state tax of 20 to 25 percent when earning more than 300,000 SEK. In addition, the employing

company pays an additional 32 percent as an Employer’s fee. (Wikipedia 2006b).

Sweden achieved its standard of living under a mixed system of both high-tech capitalism and a

welfare system. The country’s industrial output was based 90 percent on the production from privately

owned business, which 50 percent were in the engineering sector. Agriculture accounted only 2

percent (The World Factbook 2006).

The currency in Sweden is the Swedish krona-SEK (The World Factbook 2006). The disposable

income per consumption unit for individuals by age in Sweden is shown in the following table.

Table 2 The disposable income per consumption unit for individuals by age

(Median values in SEK thousand, 2004 prices) Age 2000 2001 2002 2003 2004

All individuals 140.9 144.8 148.9 149.8 153.7 0 - 5 125.6 129.1 130.6 132.0 136.7

6 - 15 125.9 131.2 135.9 136.8 141.0 16 - 19 139.8 142.6 146.1 146.5 148.8 20 - 24 132.7 135.6 132.8 135.2 138.7 25 - 34 143.0 150.8 151.8 153.4 155.8 35 - 44 139.4 146.3 150.1 149.7 154.7 45 - 54 172.1 174.5 179.6 179.2 180.4 55 - 64 187.0 184.8 193.6 197.0 203.8 65 - 74 36.0 140.2 142.7 144.8 151.5 75 up 108.4 109.2 114.1 116.7 118.8

Source: Statistics Sweden 2006a,

The disposable income per consumption unit for individuals by age


From the table, we can see that the age range of 55-64 have the highest income, while the income

decreases after a retirement. The group with the second most income is the age range of 45-54 years

old.

4.2.1.2 Population in Sweden

Inhabitants of Sweden as of December 31, 2005 was 9,047,752 people, consisting of nearly the same

number of men as women. Those aged below eighteen is 21.4 percent and those aged sixty-five and

above is 17.3 percent. Thus, the majorities of the people fall in the age range of eighteen to sixty-four

years old and represent 61.3 percent of all Swedish inhabitants as detailed in Table 3.

Table 3 Summary of population statistics 1960 – 2005

Index 2005 2004 2000 1990 1980 1970 1960

Population on 31 Dec. 9,047,752 9,011,392 8,882,792 8,590,630 8,317,937 8,081,229 7,497,967

Men 4,486,550 4,466,311 4,392,753 4,244,017 4,119,822 4,045,318 3,757,848

Women 4,561,202 4,545,081 4,490,039 4,346,613 4,198,115 4,035,911 3,740,119

Number of persons, 0-17 years 1,934,239 1,939,153 1,937,779 1,880,316 1,977,226 2,007,012 2,046,306

Persons aged 0-17 years in % of total population 21.4 21.5 21.8 21.9 23.8 24.8 27.3

Number of persons, 65 years and above 1,565,377 1,554,335 1,530,887 1,526,196 1,362,099 1,113,239 887,964

Persons aged 65 years and above in % of total population 17.3 17.2 17.2 17.8 16.4 13.8 11.8

Population growth 36,360 35,722 21,366 63,594 14,927 76,872 35,827

Population growth per 1000 inhabitants 4.0 4.0 2.4 7.4 1.8 9.5 4.8

Source: Adapt from Statistics Sweden 2006b, Population Statistics

4.2.2 Healthcare situation in Sweden

With a health care system controlled by Swecare, the non-profit organization, Sweden is ranked as

one of top leading nations in health care (Swecare Foundation 2006a). The country invests about 7.7

percent of its GNP each year in its health care system (Swecare Foundation 2006b).

Technological progress and innovation have helped to improve the Swedish health care system. The

Swedish health care program provides each person access to the best available care services

(Swecare foundation 2006b).

4.2.2.1 The structure of healthcare program in Sweden

The doctor to patient ratio in the country is about one per 330 residents. The hospitals in Sweden are

divided to 3 categories, which are, Central County, District County and Regional hospitals. Outpatient


care, including child and maternity healthcare services, are organized into primary care district. At the

District healthcare center, the doctor gives medical treatment, advisory services and preventive care.

In the country, it also provides the school health services to check the health of schoolchildren.

Approximately 77 percent of all working Swedes are covered by the Special industrial health service

(Swecare foundation 2006b).

The Swedish government also has the policy to provide the same opportunity for people who are

disable and the senior citizen. There is an organization of vision and hearing centers and specialists

(physiotherapists, orthotists, etc.) for disabled people, and generally the technical aid for them is

provided for free (Swecare Foundation 2006b).

4.2.2.2 The problem in the care systems

Although, it is said that Sweden is the leading country in healthcare system, there in fact are many

major problems that have been argued about for a long time. One of the major problems with the

system is the long waiting time. As stated in the news from Medical News today, 1.3 percent of the

people who are waiting for a bypass operation die waiting. It also mentioned that the healthcare

system in Sweden has not been able to meet the demand for services (Swedish Research Council

2005).

Because of the long waiting lists and under-capacity, patients sometimes die while they are still

waiting in the queue. The number of people who line up for a bypass operation illustrates this problem.

In western Sweden, there are approximately 1.6 million people but about 250 patients are waiting for

the operation. In addition, from the study it is shown that the mean waiting time for patients was 82

days (Swedish Research Council 2005).

Table 4 Patients on the waiting list on April 30, 2002

Procedure Percent waiting > 12 months (%)

Percent response rate (%)

PTCA 0 53

Coronary artery bypass operation 0 78

Cataract surgery 6 55

Operation for incontinence (women) 8 60

Operation for prolapse of the uterus 11 56

Hip repalcement 11 58

Knee replacment 17 58

Benign prostatic hyperplasia 24 52

Inguinal hernia operation 25 46

Cholecystectomy 29 51

Total* 18 52

Source: Hanning M 2006, Monitoring and evaluating waiting times at hospitals in Sweden

It is not only the patients that are waiting for a bypass operation that have to wait in the long queue.

Other patients who are waiting for available bed in hospitals have also complained about waiting lists.


Nowadays, the government has introduced a six-month waiting guarantee to patients (BBC NEWS

2005). The waiting time problems for patients besides those waiting for a bypass operation can be

seen in the Table 4, which illustrates percent of patients who have been waiting for more than a year.

From the opinion of Dr. Lennart Bogg, the Karolinska Institute, the most serious problem facing the

Swedish health system is the lack of responsiveness to the situation and needs of the patients and the

lack of follow-up after contact with the health system. The waiting periods are too long for both elective

care and acute care, reflecting poor management and poor planning (L Bogg 2006, pers. comm., May

3).

As mentioned by Professor Roland Svensson, there are three main problems in Swedish healthcare

system; 1) the waiting lists in some areas 2) increasing costs and higher medical efficiency which

means that the state-funded hospitals have to give priority to some health problems and 3) a growing

elderly population (R Svensson 2006, pers. comm., May 3).

Linking the phenomenon of increasing in medical tourism with the demand for medical treatments

abroad, Dr. Lennart Bogg (2006, pers. comm., May 3) believed that the medical tourism amongst

Swedish tourists has already existed and will expand. However, the continued increase in medical

tourism will affect only a marginal influence where capacity is inadequate in Sweden. Professor

Roland Svensson (2006, pers. comm., May 3) also gave us the judgment that it will helps a lot if the

Swedish health assurance system support the Swedes to get treatments abroad. However, the safe

and good quality cares are the critical factors, and language may be a limiting factor for some people

in the opinions of these two specialists.

4.2.2.3 Privatization of hospitals in Sweden

The health care service in Sweden is dominated by the public providers, which account for about 90

percent of the total. The country’s healthcare service is divided into three political and administrative

levels that are, the national government (legislation and control), the county councils (primary and

secondary care), and the local municipalities (elderly care and nursing homes). All of their activities

are financed by taxes (Lofgren 2002).

The country had to reorganize the function of its healthcare system in order to achieve this reduction

according to the European Union regulations to reduce public taxation. The country has licensed 150

private healthcare providers to compete in healthcare services. After the first five years of trial, only

one of 150 service providers was out of the business, but the rest have shown that they can operate at

a lower cost than the public healthcare does (Mitchell 2001). Moreover, the waiting time in the private

hospitals have been decreased significantly when compared with the public healthcares as can be

seen from the Figure 13.


In 2002 just under 8% of all the money that was spent from state insurance on reimbursing hospitals

for treating patients went to private hospitals (Burgermeister 2004). Patients in private hospitals are

not covered by public insurance, so only the most affluent can afford to use them (Butler 2005).

Figure 13 Waiting times at Swedish hospital

2weeks

15-25weeks

10weeks

1 yearplus

Heart Surgery Hip ReplacementSurgery

Private

Public

Source: Mitchell AW 2001, Sweden Edges Toward Free-Market Medicine

On the other hand, in 2004, the Swedish coalition government has banned the privatization of

hospitals because it is believed that the privatization will destroy the principle of fair and free health

service within the country. Under the new legislation, the private companies will not be able to buy

regional hospitals; only non-profit providers are allowed to manage hospitals. However, the existing

private hospitals still can operate their business and the private companies will also be allowed to set

up new hospitals (Burgermeister 2004).

4.2.3 Swedish traveling behavior

In this topic, there is information about the purpose of visits, expenditures, type of Swedish tourists

and their behavior, and the attraction of Phuket.

4.2.3.1 The purpose of visits

The main reason for Swedish tourists to go to travel abroad is dominated by 29.9 percent visiting

friends and relatives, followed by relaxation with 26.4 percent, pleasure and entertainment with 21.5

percent, and to be in sun and on the beach about 21.0 percent as shown in the following figure:


Figure 14 The purpose of visits 2004,

Travel with overnight stays of the Swedes’ outbound tourism

(Does not add up to 100% as several alternatives are possible)

Source: Swedish Tourist Authority 2005, Tourism in Sweden 2005, p. 31

According to the interview with Ms Veena Panjamanond Bohlin who is the marketing manager of TAT

in Scandinavia and Finland, most Swedes like to have a vacation in a place located on the sea, sand

and beach when they visit Thailand. She found that eco-tourism is not popular for Swedish people but

long-stay packages are interesting for the elderly. Visits for shopping and medical tourism are one of

the supplementary packages for holiday packages. The holiday package is a package for the tourist

that lasts about 2 weeks and there are many kinds of supplementary package in the holiday package.

These supplementary packages cover more than just shopping and medical tourism; they might also

include, for example, tracking, golf, and diving (V Panjamanond Bohlin 2006, pers. comm., May 3).

Referring to the interview of Ms Veena Panjamanond Bohlin, medical tourism in Sweden is in the early

stages. It depends on patient’s categories. If it is the big operation and an urgent case, the patient

cannot go to use the service in Thailand because of the Swedish welfare system, technology and the

distance to Thailand. For now, it will still be only a supplementary package while traveling in Thailand;

for example, the tourists who travel for 2 weeks can get a check-up program for their health, dental

treatment, and eye care. It is interesting since eyeglasses fitting and dental care in Sweden are more

expensive (V Panjamanond Bohlin 2006, pers. comm., May 3).

4.2.3.2 Expenditures

As far as the money that each person spends while he or she is traveling, for leisure trips in 2004

Swedish tourists spent approximately 774 SEK per day per person, which was an increase of 2

percent from the previous year.


Figure 15 Swedish expenditures 2004: travel with overnight stays

Source: Swedish Tourist Authority 2005, Tourism in Sweden 2005, p 32

According to Figure 15, both business and leisure travelers spent more in 2004. The business traveler

spent six point eight percent more per person and day on travel abroad with overnight stays, while the

leisure travelers also increased their average expense by two percent per person and day (Swedish

Tourism Authority 2005).

4.2.3.3 Type of Swedish tourists and their behavior

As mentioned by Taosing (cited in Chantradoan& Titanont 2005, p.64), Swedish tourists can be

divided to three categories, which are (1) the tourist who buys full packages with air ticket, including

transportation, accommodation, and activities in the destination country, (2) the tourist who buys only

air tickets and accommodations, (3) the tourist who buys only cheap flights.

The customers who buy full package are the groups that normally do not have time to find information;

families with children are also in the group. Generally, families with children are looking for more

comfort and safety during the trip. In addition, retired citizens tend to buy full packages and stay longer

than others types of customer. In contrast, the teenager tourists are likely to arrange the trip by

themselves and purchase cheap air tickets from tour agencies (Chantradoan& Titanont 2005, p.64).

Swedes have five weeks for vacation in each year (Minimal vacation time around the world 2006).

Some of the tourists spend all of their vacation in summer or wintertime, while others divide their

vacation between both periods. However, most of the Swedish tourists will spend at least two weeks

for visiting Phuket in each trip (Chantradoan& Titanont 2005, p.71).

4.2.3.4 The attraction of Phuket

Swedish tourists are more adventurous, more flexible, and more sensitive to the environment. So, the

variety of activities that the tourists can choose in Phuket makes the area very attractive to customers

and it can be considers as one of the most likely place to go (Chantradoan& Titanont 2005, p.65). The

activities that can be found in the area are; water sports, horseback riding, jungle walking, eating out,

watching a show, dancing, elephant trekking, or playing golf (Health Vision Asia Co., Ltd. 2006). The

beautiful environment on the island and white sandy beaches along the west coast make Phuket one

of the perfect places to go (Health Vision Asia Co., Ltd. 2006). To facilitate its citizens, the Swedish

government has also joined with the Norwegian government to establish a shared Consular Office,


the Royal Norwegian Consulate General and Consulate General of Sweden, in Phuket on 26 April

2006 to help and assist Swedish and Norwegian citizens in Phuket and nearby provinces (Manager

online 2006). Moreover, there is a new international school in Kamala following the Swedish

curriculum, named Phuket WINFY School, which was started by a Swedish family in 2005. The new

Swedish school offers Swedish families who want to come to Thailand to take time out from their lives

back home in Sweden. This can enable the Swedish families to take holidays during school term. The

monthly school fee is only THB 8,000 or around SEK 1510 (Persson 2006). Meanwhile, Phuket is an

attraction with a lot of conveniences for the Swedes.

As a country destination, Thailand is one of the favorite places for Swedes. The Swedish travel

publication, Travel News, presents an annual Grand Travel Award; Thailand is ranked in the “World’s

Best Tourist Country” category (Tourism Authority of Thailand 2006h). In addition, one the main

reasons that Swedish tourists go to Thailand is because they want to flee from the cold weather. Again

Phuket can be the perfect place to stay (Chantradoan& Titanont 2005, p.65) since the area has only

two seasons which are summer and rainy season (Tourism Authority of Thailand 2006b).

4.3 Bangkok Hospital Phuket

In this section, information on the Bangkok Hospital Phuket is given. There is a business summary of

the company and information on RelaxU, which is the agent of Bangkok Hospital Phuket in Sweden.

4.3.1 Overview

The Bangkok Hospital Phuket is a member of the Bangkok General Hospitals (BGH) group, a network

of fifteen private hospitals (Bangkok Hospital Phuket 2006a). With 15 hospitals nationwide (making

BGH the largest health care provider in South East Asia) and its referral centers in Russia, Cambodia,

Bangladesh, Vietnam and Great Britain, it possesses a reach exceeding that of others. Bangkok

Hospital Phuket was established on May 22, 1995 for locals and tourist, whether Thai or of any

nationalities. The company’s investment up to now is 800 million baht or about US$ 20 million.

Nowadays, there are almost 200 beds in Bangkok Hospital Phuket (Bangkok Hospital Phuket 2006b).

The hospital has been prepared as a medical tourist hub combining world technology with Thai

hospitality. A new building was established on October10, 2005 to serve this business (Bangkok

Hospital Phuket 2006a).

4.3.2 Corporate vision, mission, philosophy & objective

Bangkok Hospital Phuket has the same vision and mission as its headquarters, the Bangkok Hospital

as quoted below (Bangkok Hospital 2006)


Vision Statement “BGH group is dedicated to maintaining the highest internationally accepted

standards of medical practice by delivering quality patient care to each visitor in order to attain our

paramount objective- our patients' complete satisfaction”.

Mission Statement “We are committed to providing medical services of the highest internationally

accepted standards by employing the most appropriate and up-to-date practices and technology in all

fields of medicine. Under the guidance of a highly effective and coordinated professional management

team dedicated, both to improving the quality of patient services and to ensuring complete compliance

with the highest norms and ethics of medical treatment. We strive for total quality management

throughout our hospital for the benefit and satisfaction of our customers.”

The philosophy of Bangkok Hospital Phuket is to learn from the feelings and experiences, and share

this knowledge with each other. Moreover, Bangkok Hospital Phuket will listen to the customer and it

know that the customer have a choice. It regards the rights of customer as its duty. Amid the noise

and haste of modern life, regardless of who the customers are and their reason for coming to Bangkok

Hospital Phuket, the customer remain, first and last and always, an individual and part of a worldwide

community (Bangkok Hospital Phuket 2006i).

The objective of Bangkok Hospital Phuket is to provide high-quality services to the local people

wherever they are and for the tourists on Phuket Island. It is determined to expand the scope of the

medical professionalism to serve as many areas of Phuket Island as possible (Bangkok Hospital

Phuket 2006g).

4.3.3 The company organization and business partner

As mention earlier, the Bangkok Hospital Phuket belongs to the Bangkok hospital group or Bangkok

Dusit Medical Service Pubic Company Limited (The Winthrop Corporation 2006). Its headquarters is

located in Bangkok, Thailand. The Group’s activities are the provision of healthcare services to the

public (Business.com Inc. 2006).

The organization chart of Bangkok Hospital Phuket is attached in the appendix 1 of this paper. In

addition, we will provide some information about resources, management and marketing policies as

follow,

4.3.3.1 Resources

Bangkok Hospital Phuket has 42 full-time physicians across the spectrum of medical care and a

further 50 on a consulting basis. There is a team of dedicated nurses’ support along with well-trained

technicians. All of the employees have to undergo continuous education in their specialized fields to

guarantee that their skills remain finely honed. The necessary expertise of all hospital staff in the use

of cutting edge equipment, itself a fundamental, is not at the expense of perceived notions of


traditional national warmth, which is why Bangkok Hospital Phuket truly combines(Bangkok Hospital

Phuket 2006b).

Referring to the interview of Dr. Sompoch Nipakanont, the assistant hospital director, Bangkok

Hospital Phuket is the only hospital in the south of Thailand that has a huge investment in equipment

and technology such as MRI and sixteen slides CT scan (S Nipakanont 2006, pers. comm., April 21).

The information about financial status of Bangkok General Hospitals (BGH) group is attached in the

appendix 1 of this paper.

4.3.3.2 Management policy

According to Adhikomprapa W., Bangkok Dusit Vice President (Business Day 2006), Bangkok Dusit

Medical Services targeting to the increase the number of tourists going to Siem Reap, where no

internationally-accepted hospital operate.

From an interview with Dr.Kongkiat Kespechara, who is the hospital director, Bangkok Hospital Phuket

has collaborated with the Bangkok General Medical Complex, which is the headquarters of Bangkok

Hospital group. In addition, Bangkok General Medical Complex is one of the super specialize institutes

(K Kespechara 2006, pers. comm., April 21).

Referring to Dr. Sompoch Nipakanont who is the assistant hospital director, Bangkok Hospital Phuket

is the only hospital that is acquiring the Hospital Accreditation in Phuket province. Moreover, it gained

the ISO 9000 certification and was awarded Super Brand in 2003 and 2004. The hospital is working to

be awarded JCIA accreditation (Joint Commission International United States of America), which is

the international arm of the US-based Joint Commission for the Accreditation of Health care

Organization (JCAHO). It plans to be awarded next year. There are policies to prepare the place to

have wellness atmosphere for the foreigner with absolute healthcare system including coordinators,

translators, and insurance. Moreover, the management team has connections with the huge insurance

companies in Scandinavia to be the recommended hospital from alarm center of international

insurance (S Nipakanont 2006, pers. comm., April 21).

According to an interview with Dr. Sompoch Nipakanont, the hospital supports a doctor exchange

program with Lund University Hospital. Bangkok Hospital Phuket is setting up a Scandinavian

community in its hospital and collaborates with the organization in Sweden. Moreover, Bangkok

Hospital Phuket has close connections with several charity organizations such as Rotary, Lion, IBAP,

France club, Club Italia, etc. Moreover, it has worked with the government and private hospitals in

Thailand to transfer patients with serious cases. It also provides cardiologists to help government

hospitals and does research with the government universities in Thailand (S Nipakanont 2006, pers.

comm., April 21).

From the social responsibility perspective, Dr. Kongkiat Kespechara said that the hospital has

supported the development of a children’s center after the tsunami, established a disaster-warning


center, trained charity organizations in Basic Life Support and has been the main care provider for the

Red Cross (S Krisanarungson 2006, pers. comm., April 10).).

4.3.3.3 Medical treatment

The core service of Bangkok Hospital Phuket is treatment. It provides several treatments to the

customer, which can be separated into ten departments including medicine, dental, pediatrics, family

medicine, surgery, anesthesiology, obstetrics/gynecology, radiation therapy, radiology, and psychiatry.

The hospital is experienced in closed and open divisions of heart surgery, keyhole surgery, hip and

knee replacement, and plastic surgery. It also provides a LASIK eye correction center and a dental

clinic in the hospital. There is also a skin center that has non-surgical treatments like titan, FPL and

botox. In addition, the HBO Hyperbaric Center has oxygen treatments for diving diseases and can

provide help for other medical conditions. Moreover, it has extensive health check facilities and can

perform full body MRI, CT-scan, and 4D ultrasound. It has the most advanced immunology and

microbiology laboratory in the region with PCR (Polymerase Chain Reaction) test equipment and can

give the customer the results of advanced tests, including those for malaria, dengue fever and avian

flu, immediately (Bangkok Hospital Phuket 2006j).

4.3.3.4 Medical tourism services

As mentioned by Dr. Kongkiat Kespechara, from a medical tourism perspective the hospital has

established a package for customers who want to get treatment while traveling or who want to receive

non-queue treatment at a reasonable price. The hospital pays attention to the quality of treatment.

That means it selects highly experienced specialist doctors, high quality equipment from Europe, high

touch service, special case managers, and reasonable prices. Moreover, it provides follow up service

though the information center of Bangkok Hospital Phuket in Stockholm, Sweden, to make direct

contact with the patient. The information center of Bangkok Hospital Phuket in Sweden cooperates

with the Swedish staff in Phuket to transfer the patient’s information before and after treatment in order

to plan the best service treatment and to arrange for a five star hotel, boutique hotel or villa for the

customer. In addition, the hospital has joined with Thailand Elite and TAT to set specific programs with

agent in many countries. The hospital also has program in cooperation with the Thai airway named

Royal Orchid Holiday package; however, there is still no customer from this package. Nowadays, the

hospital has RelaxU Company as its main agent in Sweden. The hospital does promotion in foreign

markets such as Scandinavia, Germany, and Australia by doing road shows. Moreover, it has made

contact with agents in order to promote this to the target group. However, the obstacle for medical

tourism is due to the lack of clear plan of support from the government and the lack of good agents

who can create awareness and understanding of the efficiency of the hospital (K Kespechara 2006,

pers. comm., April 21).

As mentioned by Dr. Sompoch Nipakanont, the foreign patients of Bangkok Hospital Phuket in 2005

totaled about 40,000 people and almost all of them were Swedish, German, American or English. Five


percent of customers had medical tourism packages as compared to all foreign patients (S Nipakanont

2006, pers. comm., April 21).

The high season for medical tourism is during November to February. The highlight package is dental

care, the comprehensive check up program; aesthetic, joint replacement, keyhole surgery and

treatment by the heart center (S Nipakanont 2006, pers. comm., April 21).

In order to have the same standard of treatment, the hospital does not separate treatment service

between general treatment and medical tourism treatment. However, it provides a coordinator who

acts as the case manager for taking care of the medical tourism customer (S Nipakanont 2006, pers.

comm., April 21).

4.3.3.5 Supporting services

Bangkok Hospital Phuket also provides the additional services to the customers; for example on-site

service via the call center, an international medical center, multi-lingual service, emergency

evacuation, patient transfer, around the clock emergency service stand by for emergency cases,

international repatriation, cooperation with travel agents and automatic on-line service with various

international and local insurance companies. It is able to repatriate a patient to their home country if

necessary. A doctor or nurse will be provided for in-flight medical treatment (Bangkok Hospital Phuket

2006g).

In addition, the Bangkok Hospital Phuket is determined to expand the scope of its medical

professionalism to serve as many areas of Phuket Island as possible. It has developed clinics, known

as Bangkok Phuket Outreach Clinics, under the supervision of the Bangkok Hospital Phuket. The

objective of this service is to provide its services to the local people wherever they are and for the

tourists on Phuket island (Bangkok Hospital Phuket 2006h). There are partnerships with international

investors that have resulted in eleven outreach clinics island-wide, at resorts, schools and the airport,

taking the service to the customer in several languages (Bangkok Hospital Phuket 2006b).

Moreover, Bangkok Hospital Phuket aims to make patient stay comfortable and satisfying; therefore,

the hospital intends to provide friendly and efficient doctors, nurses, and multi-lingual coordinators.

The International Medical Center (IMC) at Bangkok Hospital Phuket caters exclusively to foreigners in

Phuket and nearby provinces such as Phang Nga & Krabi. A team of international coordinators speaks

a variety of languages including English, German, Scandinavian languages, French, Italian, Japanese,

Russian, and Filipino. Furthermore, Bangkok Hospital Phuket also provides assistance with insurance,

onward travel, embassy contact and repatriation; for example, SOS International Denmark,

International SOS, Euro Center Thailand, Asia Assistance, Asia Assistance Partners Thailand, Mercur

Assistance (Germany) and insurance (Bangkok Hospital Phuket 2006d).


� Phuket health and travels

Phuket Health and Travel was created to support inbound patients by providing complete services

such as information service, web correspondence, and logistics. It was a subsidiary company of

Bangkok Hospital Phuket but now it has changed to be one part of the international marketing

department (S Nipakanont 2006, pers. comm., April 21).

Phuket Health and Travel helps the customer to manage health and holiday packages include pre-

arrangement for the whole trip, all transfers, personal airport pick-up, hotel accommodations, pre-

doctor appointments, quotations for health care treatment, optional sightseeing, and night

entertainment booking (Bangkok Hospital Phuket 2006j). According to Chaisawat 2006, this e-

business project can help the customer deal with many things such as advice by e-mail or IP-

telephony.

The medical treatments offered include annual check-ups, dental treatment, MRI scanning, dialysis

treatment, rejuvenation treatments, and surgery such as plastic surgery procedures, sex

reassignment, hip or knee replacements, and LASIK (Phuket Health and Travel Co., Ltd. 2006a).

Phuket Health and Travel helps the customer to organize all arrangements as shown in the following

process (Phuket Health and Travel Co., Ltd. 2006b),

• Before traveling; It will explain what they can do for the customer for both holiday and

treatment. Two days after contact it will send the customer a quotation and if the customer is

interested, it will arrange for the customer to have discussions with a specialist though e-mail. After

that, it will send the customer a holiday package two weeks prior to departure.

• On arrival; There is a limousine to pick up the customer from the Phuket International Airport

and drive the customer to the hotel.

• At the hospital; The company also takes care of the customer in this process step by step,

o Firstly, after the patient arrives in Phuket, the patient will visit the surgeon for a

first appointment. This appointment is for the doctor to determine that the patient is in good health and

prepared for treatment. The doctor will also discuss the details of the treatment with patient and set

date and time for it. If the treatment is to be an operative one, the doctor will perform a blood test, and

measure blood pulse and pressure. The patient will be asked to sign a consent form allowing the

hospital to perform the required surgery.

o Secondly, on the day of surgery, a driver will take the patient to the hospital

again. The admission procedures will have been taken care of prior to the patient’s arrival. When the

patient arrives at the hospital, the nurses will take him/her to a private room and make preparations for

surgery.

o Finally, after the surgery the patient will be kept under observation at the

hospital for one or two days as a standard procedure. After this period, the patient will have a final

meeting with the surgeon where he will give the instructions for the post-surgery care. A date will be


set for a follow-up appointment with his/her surgeon. After this, the patient will be discharged from the

hospital and the driver will take the patient back to the hotel.

• Back home; On the day of the departure, the coordinator will meet the customer at the hotel

and pick up the customer to take him/her to the airport. The coordinator will assist in checking-in and

take the customer to a business-class waiting lounge. The patient will get all necessary post-surgery

care in home country and the patient can contact the surgeon directly by phone and e-mail.

4.3.4 RelaxU medical care

RelaxU Medical Care or RelaxU Sverige (RelaxU) is the official representative of Bangkok Hospital

Phuket. They established this formal relationship on 24 November 2005 (Royal Thai Embassy

Stockholm 2006). RelaxU joint venture with Bangkok Hospital Phuket opened an office in Sweden that

provides consultation on holistic, cosmetic and medical care in Stockholm before going to the hospital

in Thailand. The business concept of RelaxU is to provide the Swedish citizen’s high quality medical

care without long waiting times or queues and with beneficial prices. It also has aftercare and

rehabilitation at the luxurious SPA hotels (Tourism Authority of Thailand 2006e).

Sweden's generous social system provides virtually free healthcare to all residents, but queues for

treatment of non-life threatening conditions are often long (Swedish patients tired of waiting may head

to Thailand 2005). RelaxU is the hospital’s first information center abroad, which may appeal to

Swedes because prices are much lower than private care in the Scandinavian country. For example,

laser eye surgery in Sweden costs about 12,000 kronor per eye while the cost in Thailand is 14,500

kronor for both eyes. The patient may pay about the same price, but in addition to the operation,

he/she can get travel and a vacation (The Local SWEDEN’S NEWS IN ENGLISH 2006).

The target customers of RelaxU are people who already use private healthcare in Sweden. The

company hopes that the Swedish state in the future would agree to pay for certain treatments. The

Swedish nursing staff will help patients determine whether they should travel to the Southeast Asian

country for treatment (The Local SWEDEN’S NEWS IN ENGLISH 2006).

As mentioned by the management, RelaxU is the only agent in Sweden; however, in the future the

hospital intends to operate its own process by itself (K Kespechara & S Nipakanont 2006, pers.

comm., April 21).

According to an interview with Mr. Pakin Ruktae-ngam, the marketing manager of Bangkok Hospital

Phuket, pers. comm. on May 4, 2006, we collected the information of these two business partners as

follow:

RelaxU is the exclusive agent, which gets a commission payment from Bangkok Hospital Phuket. It is

supposed to provide medical information for Swedes who expect to be treated at Bangkok Hospital

Phuket. RelaxU is responsible for all marketing, management and strategies. Bangkok Hospital

Phuket will support medical services. Right now, RelaxU has an office and call center in Stockholm


and Göteborg. According to the agreement, RelaxU will combine the medical services with

accommodations. Once the patients arrive in Phuket, there is a representative from RelaxU based in

Phuket to handle and take care of the patient as a coordinator. The model is quite interesting for

specific medical treatments such as hip replacement or plastic surgery. RelaxU may ask them to fill

out documents with supporting paper.

The patient’s medical record will be kept at the hospital since it is classified as very confidential. It will

be released in only some cases if there is a request for the medical record from a proper doctor with

the proper letter of intent. Normally, patients who have strong intention to be treated here will bring

their own medical records to their own doctors. There is no doctor-to-doctor system right now. For the

follow up, the hospital has not reached to the level of follow up process. Generally, most of the cases

that have done have been considered acute care, which may not need the follow up process.

However, this is the good point for the hospital to make the system for that.

For payment, normally if patients have direct contact with the hospital, the hospital may demand a

deposit of 20 percent. However, in most of the cases it will ask the customer to pay 100 percent of a

fixed price, if available, or of estimated prices. Patients have to know the price estimate before making

decision. In most cases, patients will make payments directly to the hospital rather than to the agents.

The hospital has fixed prices in specific area such as cosmetic surgery; however, some treatments

such as dental work cannot be sold as a package since patients will have different requirements. The

cost will include doctor fees, medical equipment, operating room, and hospital room. As a normal

process, the hospital will have a "Cost Estimate" for patients before any major treatment. The cost

estimate will include the hospitalization as well. As far as currency, the hospital will accept only Thai

Baht. If necessary, it will convert from foreign currencies to Baht first. However, it is very convenient

for credit card payments since the currencies will be converted automatically.

Combining medical services with tour packages is in its early stages. The hospital has contacted

several agencies, both domestic and international, but has not yet reached a final solution.

4.4 The results of survey research

As we mention in the methodology chapter that we did not find much information on the demand for

medical tourism in Sweden from our literature search. To study this type of demand, we did survey

research by distributing questionnaires to 400 respondents. The information in this part is the result

of our survey, which was divided into four parts: general information about the respondents, their

opinions about Thailand, medical services in Sweden, and service packages for medical tourism.

4.4.1 General information of the respondents

We have interpreted the information from 400 people, 51 percent of them are female and 49 percent

are male. We categorize the age ranges in to four groups; people below 18, who does not become sui


juris according to Swedish law, two groups of adult, and the pensioners. The age range between 18 to

35 years old is the biggest group; it is 64.3 percent of all respondents as shown in Table 5. The

pensioners are the smallest group of respondents due to their farsighted and we cannot inform them in

Swedish language. .

Table 5 Age and gender of the respondents (400 persons)

General data Frequency Percent

Age

Below 18 39 9.7

18-35 257 64.2

36-65 95 23.8

Over 65 9 2.3

Total 400 100.0

Gender

Male 196 49.0

Female 204 51.0

Total 400 100.0

The respondents who are single made up 50.5 percent, and married or living with partner were 43.3

percent. As far as educational background, the largest sample size graduated from an upper

secondary school. Students were 217 of the 400 persons or 54.3 percent since they were cooperative

and almost of them could interact using the English language. Other details are in Figure 16.

Figure 16 General Information of the respondents (400 persons)

Marital Status

43.3%

50.5%

5.0%1.2%

Married/Living with partner

Separated/Divorced

Widowed

Single

Educational Background

11.7%

51.5%

36.8%

Nine-year compulsoryschool

Upper secondary school

University/university collegedegree

Occupation

14.0%

54.2% 6.0%

19.2%

0.8% 5.8%

Government employee

Trade and industryemployeeSelf-employed

Student

Housewife/Househusband

Children younger than 18 in the household

74.8%

13.0%7.5% 3.5%1.2% 0

1

2

3

more than 3


4.4.2 Opinions about Thailand

Since the destination for medical tourism in our project is Thailand, we have asked some questions to

study the opinion of respondents about Thailand and the city that they like most. The choices of

provinces we offered are target destinations of long-stay and medical healthcare in government

project of Asia’s healthcare hub as we previously mentioned.

Table 6 Opinions about Thailand

Opinions Frequency Percent

Have been there 83 20.8

Would like to visit 236 59.0

Have just heard about this country 67 16.7

Other 14 3.5

Total 400 100.0

According to Table 6, 20.8 percent of the people we asked have visited Thailand and 59 percent or

236 respondents would like to visit. The most favored city is Bangkok when compared with other

target provinces since we ignored the choice of other. Phuket, which is our target destination, is the

place that 25.5 percent of respondents liked the most, as illustrated in Figure 17.

Figure 17 Favorite destination

27.5%

25.5%4.0%14.0%

29.0%Bangkok

Phuket

Chiang Mai

Koh Samui

Other

4.4.3 Opinions in medical service in Sweden

The problems of local healthcare services should influence people to look for the medical treatment

abroad. Hence, this part of our research aims to study the Swedes’ opinions of their local healthcare

system.


A half of respondents feel that the general service in their local hospitals is good. The percent

cumulative of opinions for this question from very good to okay is 93.6. Only 5.2 percent feel the

general service is fair and 1.2 percent of respondents feel it is poor as detailed in Table 7.

Table 7 Opinions in a medical service of local hospitals

General service Waiting times Opinions

Frequency Percent Percent Cumulative Frequency Percent Percent

Cumulative Very good 55 13.8 13.8 17 4.3 4.3 Good 200 50.0 63.8 106 26.5 30.8 Okay 119 29.8 93.6 166 41.5 72.3 Fair 21 5.2 98.8 90 22.5 94.8 Poor 5 1.2 100.0 21 5.2 100.0 Total 400 100.0 400 100.0

In case of a long queue, the major group of respondents, which is 41.5 percent of them, feels that the

waiting line for a serious health problem is okay. The percent cumulative is 72.3. Meanwhile the

number of Swedes who feel positive about their country’s service in the healthcare system is

illustrated in Figure 18.

Figure 18 Rating of a general service and waiting line provide by the local hospitals

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Very good Good Okey Fair Poor

opinion

perc

en

t

service

wating line

However, our literature review and interviews of people in a field of healthcare illustrated that Sweden

has a good welfare in healthcare services but it faces problems of long waiting lines for admission to a

hospital as we mentioned earlier. Thus, we did a cross tabulation of age, educational background and

the opinions on waiting in a queue to study this in detail, as shown in Table 8.


Table 8 Opinions in the waiting line

Percent rating regarding the waiting line Age Educational Background Very

good Good Okay Fair Poor Total (%)

Nine-year compulsory school 2.6 25.6 20.5 2.6 2.6 53.8

Upper secondary school 7.7 17.9 12.8 7.7 46.2 Below

18 Total 10.3 25.6 38.4 15.4 10.3 100.0

Nine-year compulsory school 1.6 1.2 0.8 0.8 4.3 Upper secondary school 1.9 13.2 23.3 14.0 2.7 55.2 University/university college degree 1.2 12.4 18.7 7.4 0.8 40.5

18-36

Total 3.1 27.2 43.2 22.2 4.3 100.0 Nine-year compulsory school 1.1 4.2 5.3 3.1 13.7 Upper secondary school 2.1 7.4 21.0 11.6 4.2 46.3 University/university college degree 2.1 12.6 13.7 9.5 2.1 40.0

36-65

Total 5.3 24.2 40.0 24.2 6.3 100.0 Nine-year compulsory school 11.1 11.1 22.2 Upper secondary school 22.2 22.2 University/university college degree 11.1 11.1 33.4 55.6

Over 65

Total 33.3 22.2 44.5 100.0

Almost all age ranges, except for seniors, feel okay with the waiting line for hospital admission and

44.5 percent of pensioners mention that it is fair. In our opinions, the elder may have more frequency

to perceive this kind of service so they feel less satisfied than younger people.

Figure 19 Healthcare abroad considerations and worry of waiting for admission

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Stronglyagree

Agree Neitheragree nordisagree

Disagree Stronglydisagree

opinion

perc

en

t Considering ofhealthcare abroad

Worry to waitbefore gettingadmission

If the respondents have troubles getting treatment at their hospital, 39.8 percent of them agree to

consider a healthcare provider abroad and only 22 from 400 people (for 5.5 percent) strongly

disagree, as shown in Figure19 (or see details in the Table 20, appendix 5). According to the survey

results in Figure19, they are also worried that they might have to wait for a long time before getting


hospital admission in Sweden since the answers of Agree are 34.5 percent of the total (see details in

Table 20, appendix 5).

Moreover, a cross tabulation between age, educational background and the opinions in considering

health care abroad (see Table 21, appendix 5), show there are the same ideas for respondents in

each age range and educational level that they do agree to consider health care abroad. Moreover,

the seniors who graduated at the degree level strongly agree with this idea.

However, information in Table 9 shows that those below the age of 18 have different ideas about a

long waiting time to get hospital admission in Sweden when compared with the other age groups since

51.3 of them feel neither worried nor not worried with this problem. In addition, we did not pay

attention in this group since they do not reach a legal age. We are interested in the middle age groups

since they can have their own decisions to travel abroad and have a medical treatment. We found that

the age between 36-65 have more worry about a long queue than the group of age 18-36 as illustrated

in the Table 9.

Table 9 The worry about a long waiting times to get admission in the hospital

Feel worry to wait for a long time (%) Age Educational Background Strongly

Agree Agree Neither Disagree

Strongly

Disagree Total (%)

Nine-year compulsory school 2.6 7.7 30.8 10.2 2.6 53.9

Upper secondary school 15.4 20.5 10.2 46.1 Below 18

Total 2.6 23.1 51.3 20.4 2.6 100.0

Nine-year compulsory school 1.2 0.4 2.7 4.3 Upper secondary school 2.3 19.1 17.5 13.6 2.7 55.2 University/university college degree 2.3 12.5 9.7 14.4 1.6 40.5

18-36

Total 4.6 32.8 27.6 30.7 4.3 100.0 Nine-year compulsory school 2.1 4.2 6.3 1.1 13.7 Upper secondary school 3.1 25.3 4.2 13.6 46.2 University/university college degree 1.1 13.7 11.6 12.6 1.1 40.1

36-65

Total 6.3 43.2 22.1 27.3 1.1 100.0 Nine-year compulsory school 11.1 11.1 22.2 Upper secondary school 22.2 22.2 University/university college degree 33.3 11.1 11.1 55.6

Over 65

Total 44.4 11.1 44.4 100.0

4.4.4 Service packages for medical tourism

We aimed to explore the demand for medical tourism in Thailand as mentioned in our problems

identification. Thus, we had a question to study how to communicate with this target group. The

service packages that the prospective group expected to receive were also surveyed. Finally, we


studied the degree of interest in medical treatment that the Bangkok Hospital Phuket and other

hospitals provide.

4.4.4.1 Sources of information on traveling abroad

In studying the sources of information that the respondents use for choosing a destination for traveling

abroad, the result was that the internet is a major sources of information; along with word of mouth

from people they knew (for instance, friends, colleagues, relatives and other experience people); and

travel brochures, as illustrated in Figure 20 (For more details in number and percent see Table22 in

appendix 5).

Figure 20 The first three ranks of the sources of information

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

1 2 3

ranking order

perc

en

t

Friends/relative./colleague/experienced personInternet

Travel Brochure/GuidebookNewspaper/Magazine

Travel Agency

TV travel program

Tourist boards

Previous Visit

Nevertheless, we concentrated on a group of Swedish people who have been in Thailand and another

group who would like to visit Thailand since these groups have more potential to visit.

Table 10 The sources of information for choosing the destination,

In case of the respondents who have been in Thailand

the first rank the second

rank the third rank Source of information No. % No. % No. %

Friends/relative./colleague/experienced person 22 26.5 18 21.8 16 19.3

Internet 34 41.0 14 16.9 15 18.1

Travel Brochure/ Guidebook 5 6.0 22 26.5 20 24.1

Newspaper/Magazine 2 2.4 8 9.6 10 12.1

Travel Agency 5 6.0 9 10.8 4 4.8

TV travel program 1 1.2 4 4.8 7 8.4

Tourist boards 3 3.6 2 2.4 7 8.4

Previous Visit 11 13.3 6 7.2 4 4.8

Total 83 100.0 83 100.0 83 100.0


In accordance with the Table 6, the numbers of respondents who have been to Thailand total 83

persons. We found that 41 percent of them use the internet to search for information, 26.5 percent are

influenced by people they knew and 13.3 percent of them had made a previous visit as in detailed in

Table 10.

For the people who aim to visit Thailand, which are the biggest group of respondents, we discovered

that 45.8 percent of them search for their destination of traveling abroad through the internet. Word of

mouth was second with 29.7 percent on the first rank as illustrated in Table 11. Meanwhile, these two

groups have the same sources of information as other groups of respondents.

Table 11 The sources of information for choosing the destination,

In case of the respondents who would like to visit Thailand


rank the third rank Source of information No. % No. % No. %

Friends/relative./colleague/experienced person

70 29.7 58 24.6 35 14.8

Internet 108 45.8 57 24.2 24 10.2

Travel Brochure/ Guidebook 24 10.1 48 20.3 48 20.3

Newspaper/Magazine 6 2.5 21 8.9 35 14.8

Travel Agency 11 4.7 15 6.3 30 12.7

TV travel program 4 1.7 11 4.7 28 11.9

Tourist boards 4 1.7 11 4.7 15 6.4

Previous Visit 9 3.8 15 6.3 21 8.9

Total 236 100.0 236 100.0 236 100.0

However, we found that people who are between 18 and 35 years old use the internet as their major

source to search their destination for traveling abroad, 51.4 percent of them rated the internet on the

first rank and 30.0 percent asked for information from the people they knew. In contrast, the age

between 36 and 65 give the priority to people they knew to be the sources of information more than

the internet. As illustrated in the Table 23, appendix 5, that 37.9 percent of them ranked friends,

relative, colleagues and person who have experienced in that destination at the first source and 30.5

percent of this group selected the internet.

4.4.4.2 The important factors in a medical treatment

After a discussion with the hospital director and the marketing manager of Bangkok Hospital Phuket

and our tutor who is Swedish, we offered seven factors that the respondents might choose if they

wanted to receive medical treatment. The result of the ranking order is illustrated in Figure 21.


Figure 21 The important factors in a medical treatment

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

1 2 3

ranking order

pe

rce

nt

Large spectrum of differenttreatmentExcellent medicalequipment Professional and qualifiedmedical personnelHospitable of a hospital’sstaff

Attractive and reasonableprices for treatment International Accreditation

An interpreter andinformation in SwedishAn interpreter andinformation in English

Professional and qualified medical personnel are the major factor for decision-making if the

respondents want to obtain the treatment; the second factor is excellent medical equipment (see

details in Table 24 of the appendix 5). Although price is not a major factor for which the Swedish

respondents expressed concern, we tried to study the relationship between the perception of price and

the age ranges as well as price and occupations. This information will be useful for us to suggest a

price strategy in the analysis part. We found that the under 18 age group and the age group of 36-65

is more concerned with an attractive and reasonable price for a treatment, as illustrated in the first

rank of Table 12.

Table 12 The concerning in attractive and reasonable price between ages

Percent of rank in an attractive and reasonable price Age

The first rank The second rank

The third rank

Average of the first three rank

Below 18 12.8 20.5 23.1 18.8 18-36 6.6 15.2 14.0 11.9 36-65 11.6 11.6 10.5 11.2 Over 65 0.0 22.2 33.3 18.5

People who are trade and industry employees have more concern with price than other groups as

shown in the first rank of Table 13. However, if we evaluate the rankings by considering the first three

ranks, 33.3 percent of the housewives or house husbands were concerned with price.

Table 13 The concern for an attractive and reasonable price in each occupation

Percent of rank in an attractive and reasonable price Occupations The first

rank The second

rank The third

rank Average of the first three rank

Government employee 8.9 19.6 14.3 14.3

Trade and industry employee 14.3 10.4 9.1 11.3

Self-employed 4.2 25.0 4.2 11.1

Student 6.0 13.8 15.7 11.8

Housewife/Househusband 0.0 33.3 66.7 33.3

Others 13.0 17.4 26.1 18.8


4.4.4.3 Supporting services of medical treatment

Medical tourism is a service package that needs supporting services before and after treatment since

the medical tourists are in a different country with the medical tourism suppliers. According to the

survey research, correspondence with the doctor is of concern for 62.8 percent of respondents, along

with accommodation services as shown in Figure 22.

Figure 22 The supporting services before and after treatment

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

1 2 3

ranking order

pe

rce

nt

Flight reservation

Accommodation service

Correspondence with thedoctor Transfer between airport,hotel and hospital Tourism package

Online consulting service

Follow up visit

In evaluating the wants of respondents in each group, we found that the retired citizen is more

concerned with accommodations than other groups. It is interesting that the follow up visit had very

low demand for all of age ranges (see details in Table 26 in the appendix 5). The opinions on these

supporting services do not vary much between occupation groups or between educational levels (see

Tables 27 and 28 in the appendix 5).

4.4.4.4 Interest in medical treatment

In this part, we wanted to know if the respondents were to visit Thailand whether or not they would be

interested in the medical treatments offered by private hospitals in Thailand. However, there are few

degrees of interest among the respondents. Figure 23 illustrates the mean of interest in which the

highest mean is dental treatment, along with LASIK and urgent treatment. Moreover, the standard

deviations in every answer are more than one (see the Table 29 in appendix 5). Meanwhile the

answers vary between each respondent. This can imply that the respondents have a varying interest

in each treatment.


Figure 23 Mean of interest in medical treatment

(n=400)

0.00

0.50

1.00

1.50

2.00

2.50

3.00

me

an

of

inte

res

t

Annual check-ups

Dental treatment

LASIK

MRI scanning

Rejuvenation treatments

Plastic surgery

Hip or kneereplacements

Urgent treatment

To ensure that the results are useful enough, we omited people who just heard about Thailand since

they will have less interest than people who have ever been there or would like to go to this country.

Hence, our sample size is reduced to 319 respondents and the results is in the Table 14

Table 14 Mean of interest in medical treatment in case of people who would like to visit Thailand and people who have been in Thailand

age between

18-65 age below

18 & age over 65 Total Treatments Mean N Mean N Mean N Annual check-ups 2.26 276 2.74 43 2.33 319 Dental treatment 3.05 276 2.81 43 3.02 319 LASIK 2.41 276 2.28 43 2.39 319 MRI scanning 1.99 276 2.30 43 2.03 319 Rejuvenation treatments 1.98 276 2.19 43 2.01 319

Plastic surgery 1.98 276 1.98 43 1.98 319 Hip or knee replacements 2.08 276 2.40 43 2.13 319

Urgent treatment 2.26 276 2.91 43 2.36 319

Table 14 shows that dental treatment has the highest mean of interest. We calculated mean of interest

of people, whose age between 18 and 65 as illustrated in the Table 14, the highest mean is 3.05,

dental treatment along with 2.41 LASIK. Furthermore, the results of 319 respondents who have been

in Thailand or who would like to go to this country are same as the results for all 400 respondents.

In conclusion, The Swedes worry about the long waiting list to get admission in their local hospitals but

almost of them feel okay in the services that the hospitals provide. They also agree to consider the

healthcare providers abroad if they have troubles getting treatment at their local hospitals. However,

the degrees of interest in the medical treatments offered by private hospitals in Thailand is not much.

The highest mean is dental treatment and LASIK is the second treatment of interest. The operation

treatments in both plastic surgery and other serious cases surgery are not much concern.


4.4.5 The results of survey research in brief

To make more convenience for the readers who want to know the results of our survey research in

brief, we summarize the results as follow:

Figure 24 The summary of survey results

Part of questionnaire Results

General information of the

respondents

• From 400 Swedish respondents, 51% are female& 49% are male

• The age range between 18-35 years old is the biggest group (64.3 %)

• 50.5% of the respondent are single & 43.3% are married or living with partner

• the largest sample size graduated from an upper secondary school

• Students were 217of the 400 persons (54.3%)

Opinions about Thailand

• 20.8% of respondent have been in Thailand and 59% of them would like to visit

• The most favorite city is Bangkok (27.5%), while Phuket is the second rank (25.5%)

Opinions in medical service in

Sweden

• A half of respondents feel that the general service in their local hospital is good and the percent cumulative of opinions from good to okay is 93.6%

• 41.5% of the respondent feel the waiting line for a serious health problem is okay; however, 44.5% of pensioners mentioned that it is fair

• 39.8 of the respondent agree to consider a healthcare provider abroad

• 36-65 years of age have more worry about a long queue than the group of age 18-36

Service packages for medical

tourism

• Internet is a major sources of information, along with word of mouth from people they knew and travel brochures

• The people 18-35 years old use internet as the major source, 51.4% rated the internet on the first rank& 30.0% asked for information from the people they knew; while, the age between 36-65 give the priority to people they knew (37.9%) to be the sources of information more than the internet (30.5%)

• Professional& qualified medical personnel are the major factor for decision-making and the second factor is excellent medical equipment

• Price is not major concern; however, the person age under 18 & 36-65 is more concerned with an attractive price for a treatment

• Correspondence with the doctor is of concern for 62.8%of respondents, along with accommodation services

• Retired citizen is more concerned with accommodations than other groups

• The highest mean of interest in medical treatment is dental treatment, along with LASIK and urgent treatment


5 Analysis

As we mentioned in the theoretical chapter, the collaborative strategic tourism marketing planning

process can be divided into three key sections. First, situational analysis should be done. Second,

strategic choices should be made in the strategic tourism marketing planning process. Then, strategic

tourism marketing should be implemented. However, as researchers, we have no authority to make

decision on the stage of strategic tourism marketing. Thus, we will offer a marketing mix of eight Ps in

this last stage.

5.1 Situational analysis

In the situational analysis stage, we aim to study the commitment of the hospital to do the business,

which is medical tourism in this case. Furthermore, the purpose of situational analysis is to identify the

key external opportunities and threats facing the organization, as well as to audit the internal factors to

identify the strengths and weaknesses of the Bangkok Hospital Phuket.

5.1.1 Strategic context and marketing audit

The corporate vision can help us to perceive the picture of organization and its generic direction to do

business. According to the corporate vision and mission, Bangkok Hospital Phuket is committed to

maintaining the highest internationally accepted standards of medical practice. It also aims to provide

medical services of the highest internationally accepted standards and to improve the quality of patient

services as well as to ensuring complete compliance with the highest norms and ethics of medical

treatment. These will encourage the company to be accepted in the international market. In

developing a medical tourism business, Bangkok Phuket Hospital has a clear policy to fulfill its

objective to provide high-quality services for the tourists on Phuket Island. It has established its own

website, Phuket Health and Travels, to promote this business. According to Dr. Kongkiat Kespechara,

the hospital director, the company is also interested in the Swedish market. Commitment of the

management is one of the key factors in accomplishing this strategy.

5.1.1.1 External audit

Medical tourism is a new trend for the tourism business in Thailand since the government is promoting

the country to be a health care hub of Asia. The hospital may gain many opportunities from this policy.

However, according to the hospital director of Bangkok Hospital Phuket, there is insufficient support

from the government in practicality. Furthermore, this kind of service is familiar only to a small group

of Swedes, due to the fact that Sweden is a leading country in healthcare field, as we mentioned

earlier. Although the country faces problems with long waiting times that can cause some people to

die while they are waiting for their operation, our research results illustrated that the Swedish people

feel comfortable with the healthcare services provided in their country. In the empirical findings


chapter, it illustrated that 93.5 percent cumulative feel okay with the general service of their local

hospitals and 72.3 percent cumulative rates that the waiting line is okay. Meanwhile the target

customers of Bangkok Hospital Phuket tend to use the services supplied by their own country.

According to the TAT Stockholm, there is no tour operator that exactly provides a medical tourism

package and TAT Stockholm has no policy to promote the medical tourism directly since it is too new

in the market and too much of a niche for a government tourism promoter, which has to promote

Thailand in a larger view. This is can imply that the tourism life cycle stage for this service is the

introductory stage.

In order to gain access to the market, it is necessary to analyze the competitors. Although Thailand

has a number of private hospitals that provide medical treatments from a medical tourism perspective,

its location on Phuket Island can help the Bangkok Hospital Phuket to position itself to avoid

competition from the high reputation Hospital in Bangkok, the capital city of Thailand. As we have

discussed in the empirical chapter, there are only two hospitals following international standards in

Phuket; Bangkok Hospital Phuket and Phuket International Hospital. Because of the tsunami disaster,

Bangkok Hospital Phuket established a good reputation among the Swedish people. Although there is

a lack of information on market share, the investment in high technology equipment, the larger

capacity, and its business network in Stockholm imply that the company can compete with its rivals in

Thailand. However, in providing medical treatment services for the Swedes, private hospitals in

Sweden and other international hospitals that offer their services to this market are rivals as well. Even

if RelaxU takes responsibility for the marketing function for medical tourism in Sweden, the hospital

should study its rivals to learn more about their service processes and strengthen itself for

competition.

5.1.1.2 Internal audit

As a member of Bangkok General Hospital group, which is the largest health care provider network,

Bangkok Hospital Phuket has good monetary support from its headquarters. The management’s

commitment to employ both the best staff and the best equipment as illustrated in the company

objective can be an attractive promise to the customers that the hospital is available for international

standard services. The human resources management, for instance, cooperates with Lund University

in Sweden and encourages its staff to have a continuous education in their specialized fields. This can

facilitate the hospital to provide its medical services. In offering medical tourism, the hospital has the

Phuket Health and Travel website to communicate with its prospective customers. It has also invested

in a new building with good facilities to make things easier for inbound patients. However, the

company seems to be dependent on its agent in Sweden since for Bangkok Hospital the two

companies have a dyadic relationship. In contrast, RelaxU may establish its network relationship with

other hospitals. Hence, this could be risk for the company.


5.1.2 SWOT analysis

The SWOT analysis is the technique that can be applied in evaluating the potentials and limitations of

Bangkok Hospital Phuket, as well as the strengths and weaknesses of the company.

5.1.2.1 Internal analysis of Bangkok Hospital Phuket

Although the company can control it own operation, an internal environmental scan can help the

business to build up more strengths and solve its limitations. After the internal marketing audit, we

identified the strengths and weaknesses of the Bangkok Hospital Phuket. Figure 25 illustrates the

strengths and weaknesses of the company.

Figure 25 Strengths and weaknesses of Bangkok Hospital Phuket

Strengths Weaknesses

� Located at a tourist attraction � Has only one agent in the Swedish market

� Is a member of the largest health care provider network in South East Asia

� Lack of a good monitoring in its marketing tasks

� High investments in technology and equipment

� Is in the process of applying for international accreditation

� Good educational support for its staff

� Has gained international standard certification

� Closely connected with many charities and government organizations

� Professional in various kinds of treatments

� High commitment in medical tourism service

� Better price

Source: Authors’ analysis

� Strengths

Bangkok Hospital Phuket is located on Phuket Island, which is a good attraction since it won the

favored travel destination award in the year 2005. Although the city is not the favorite destination of

the respondents in our survey, it is the one of second interest. A good attraction should make it easy

to arrange tourism packages for its medical tourists.


As a member of the hospitals in Bangkok General Hospital Group; the largest healthcare provider

network in South-East Asia, the hospital can obtain a good monetary support and gain cooperation

from the hospitals’ network to transfer patients and share other facilities. Moreover, being in Bangkok

Hospital Group makes it to better known and increases the confidence of its customers.

As mentioned by Dr. Sompoch Nipakanont, the Bangkok Hospital Phuket is the only hospital in the

southern part of Thailand that has invested a huge budget in its equipment. Up to now the company

has invested around US$ 20 million. This large investment in technology and equipment allows the

hospital to provide higher technology treatment than other hospitals.

The hospital provides good educational support for its staff and has good connections with Lund

University Hospital in Sweden. This relationship not only increases the knowledge of its subordinates

but also helps the company establish a good image among Swedish customers.

Being certified by an international standard organization, such as having the ISO 9000 certification

and other awards, increases the credibility of the hospital.

The hospital is closely connected to many charity organizations and cooperates with government

hospitals and universities, as said by Dr. Sompoch Nipakanont. This good local network support can

encourage the company to have more quality in its services.

Professionals with experience in various kinds of treatments; for instance, closed and open heart

surgery, keyhole surgery, hip and knee replacement, and plastic surgery helps the hospital to be

accepted in international market.

The hospital pays attention to the medical tourism package, which makes it have complete services

for customers in medical tourism business. It has invested in a new building with high facility for

preparing it as a medical tourism hub. The hospital also recruits highly experienced specialist doctors,

imports high quality equipment from Europe, and provides other facilities to support this business as

we have mentioned previously. Meanwhile, the hospital is able to take care of inbound patients. It also

has agent in Sweden in offering the Swedish medical tourists.

The treatment services offered by Bangkok Hospital Phuket are much cheaper than the prices of

services at private hospitals in Scandinavian countries. This can strengthen the hospital, allowing it to

gain more bargaining power than its international competitors.

� Weaknesses

According to Mr. Pakin Ruktae-ngam, the hospital uses RelaxU as the agent responsible for all

marketing strategy in Sweden. This dependent relationship with one agent could be a high risk if

RelaxU does not focus on this business or relationship.


The hospital has cooperated with other travel business organizations through such methods as the

medical check-up package with Royal Orchid Holiday, a department of Thai airways. However, there

are still no customers for this package as mentioned by Dr. Kongkiat Kespechara. It implies that the

hospital lacks a good monitor for its marketing tasks.

Although the hospital is in the process of being awarded international accreditation from the Joint

Commission International United States of America, it is a weakness from our point of view since this

kind of certificate plays an important role in the international hospital standards. Moreover, the

company objective’s claims that it aims to provide high-quality services that could be an over promise

if it does not meet this certification.

5.1.2.2 External analysis of Bangkok Hospital Phuket

For the external analysis, we analyze both the influence factors from Thailand and Sweden, which is a

target market for Bangkok Hospital Phuket. Figure 26 shows the opportunities and threats for the

company.

Figure 26 Opportunities and threats of Bangkok Hospital Phuket

Opportunities Threats

� Convenience of Visa system � Effect from the appreciation of Thai currency

� Gain from Joint Plan of Action between Sweden and Thailand

� Great distance from Sweden

� Thailand has a good image and impression for the Swedes

� Insufficient support from Thai government

� The tsunami disaster helps the hospital to be well known in Sweden

� A low acceptance of the Swedish people for medical treatment abroad

� The Swedes facilities in Phuket � A poor expectation in quality of treatment in Thailand

� A less interest of tourism promoters in medical tourism

Source: Authors’ analysis

� Opportunities

From the information in our empirical findings, we discovered that Swedish tourists could stay in

Thailand for up to thirty days with no visa requirement. The Swedes who would like to stay in Thailand

more than thirty days can also proceed with the “Fast Track Visa” system. Relaxing the rules and

regulations by Thai government should facilitate the tourists who want to visit Thailand and can

encourage them to obtain the medical tourism package as well.


According to the Joint Plan of Action, signed by Thai and Swedish government, the hospital can

benefit from promotion activities.

Thailand has a good image among the Swedes since the results of our survey illustrate that 79.8

percent of respondents are people who have been to Thailand or are people who would like to visit the

country. Moreover, Thailand won the Swedish “Grand Travel Award for the World’s Best Tourist

Country” as we mentioned earlier. This positive image should influence the demand of tourists to be

customers of the Bangkok Phuket Hospital if the company provides the appropriate services to them.

Although the tsunami disaster was a bad threat to a number of businesses, especially in tourism

industry, Bangkok Hospital Phuket gained the opportunity. It has enthusiastically supported and

helped the victims of the tsunami disaster. Its high social responsibility and hospitality develop a good

reputation for the company.

As mentioned previously, Swedes should feel convenience when visiting Phuket since the Swedish

consulate located there and the Swedish international school helps the families to enable their long-

stay in this island. These facilities not only make the Swedes fell comfortable when visit Phuket but

also make them to confide with their own culture.

� Threats

The present appreciation of Thai currency could affect the business. The higher value of currency will

cause the cost of treatment to be higher when converted to the foreign currency.

The great distance to Thailand should be a concern for patients in need of serious treatment due to

the fact that they cannot transfer to the hospital, which is too far from their home country, as

mentioned by Ms Veena Panjamanond Bohlin.. Moreover, the total cost of the medical tourism

package might higher than getting the treatment nearby Sweden since the cost of transportation might

be cheaper. This is a major threat since medical tourists would not want to obtain treatment in

Thailand if they do not aim to visit the attraction on their holidays.

From our literature search, there seems to be a positive impact to the medical service providers as a

result of the center of excellence of Asia campaign. However, Dr. Kongkiat Kespechara claims that

inadequate support from the government is a threat for some private hospitals including Bangkok

Hospital Phuket.

As we mentioned earlier, although there is a long waiting times to get admitted into local hospitals, the

Swedish people still hold their local health care in high regard. They also have relatively low interest in

the medical treatment outside Sweden. The hospital should face this problem to increase its service

volumes


The higher quality of treatment in Sweden than in Thailand is one of the most important things that has

to be of concern, as mentioned by Dr. Lennart Bogg. It shows that Swedes are not certain of the

quality of treatment in Thailand.

According to interviews with the management of TAT Stockholm, we learned that there are no tourism

promoters in Sweden, which provide medical tourism packages directly. A holiday package, provided

by Royal Orchid Holiday also has no clients since it is not of interest to tourism promoters

In conclusion, the result of SWOT analysis shows more internal strengths and external threats. Hence,

the S-T strategies should be applied. Meanwhile, the hospital has to decrease the impact of external

threats by using its strengths.

5.2 Strategic tourism marketing planning

After performing the SWOT analysis, we found that the hospital has a number of strengths as well as

threats. The result of the SWOT analysis is good information to support the marketing plan. To assist

in developing strategic tourism marketing plan, we offer the proper generic strategy for the company

and determine the STP

5.2.1 Choosing the generic strategy

According to generic strategic options that we mentioned in the theoretical framework chapter, we

suggest that the differentiate strategy should be suitable for Bangkok Hospital Phuket. Although the

cost of treatment in Thailand is much cheaper than in private hospitals in Sweden and other Asian

countries such as Singapore, Hong Kong, the overall low-cost leadership approach is not a proper

way in our opinion since it could affect the quality of equipment, personnel development and other

resources. Moreover, the hospital is committed to providing high-quality services for the tourists on

Phuket Island. In addition, the focusing strategy is not a suitable strategy as well since it requires the

hospital to develop strong relationships with existing and potential customers as we stated in our

theoretical chapter. Medical tourism provided by Bangkok Hospital Phuket is typically something new

for Swedish customers since the hospital has just signed the contract with its agent last year. These

are the reasons why differentiate is the appropriate generic strategy for the company at this time.

5.2.2 Market STP

The core of the strategic marketing planning process is that of market segmentation, targeting and

positioning. In this part, we will offer STP for the Bangkok Hospital Phuket.

5.2.2.1 Market segmentation

The survey results for the degree of interest in medical treatment shows a high value of standard

deviation. In addition, Swedes have the diverse levels of interest in medical treatment packages since


the Bangkok Hospital Phuket provides the variety of medical treatments and it is impossible for them

to suitable for all groups of people. Thus, in segmenting the market, the company should use

personal bases. The market should be divided into two segments, one for a tourist who comes

primarily for leisure and includes a check-up or a simple procedure during his or her holiday, and one

for a tourist whose destination is the hospital. We define these two groups as a leisure tourist and a

specifically medical treatment tourist.

Each segment should be subdivided by the other methods of segmentation. For instance, in offering

service packages to the leisure tourists, the traveling behavior and the demographic profiles should be

taken into consideration. As mentioned previously, all individuals Swedes have disposable income

approximately 153,700 SEK per consumption, according to a good welfare system, they have income

in every age ranges. Thus, the Swedish tourists have much purchasing power to be the hospital’s

clients. The two-week length of stay as stated earlier should be a trouble-free to add a simple medical

treatment package. The tourists who buy full packages include the activities in the destination should

be a target. However, the hospital may get in touch with tour operators to offer common treatments

package such as teeth whitening, dental check up, visual examination and eyeglass fitting, and annual

check up to be an activity in their service packages. Segmenting the specific treatment tourists, the

patients need, motivations, and benefits sought should be undertaken.

5.2.2.2 Targeting

Before adapting the marketing mix, the company has to target its market. Since the market is divided

into two segments as mentioned previously, the Bangkok Hospital Phuket should apply selective

specialization patterns to persuade its target. However, in providing the medical tourism, it should

include a number of organizations cooperating to take care of a tourist from before his or her

departure until their return back home after an impressive experience.

A leisure tourist is more the responsibility of the travel agencies or tour operators than the hospital

since the medical package is a simple procedure that does not take a long time for treatment and

recuperation. The target group should be people who want to visit Phuket on their vacation and expect

to perceive some simple treatments that have the same standard of quality but cheaper than the

treatments in Sweden.

In contrast, a specifically medical treatment tourist aims to have a specific treatment at the hospital

directly. Recuperation is needed for a longer time than required by the first segment and they will

spend perhaps a couple days for leisure time. Additionally, the main responsibility for taking care of

this target should lie with the hospital. This target group should be the Swedish patients who face with

a long waiting times and willing to pay for their treatments in stead of waiting for free treatments in the

public healthcare.


Moreover, to meet its customer’s satisfaction, the company has to study the demand of each target by

subdividing them along the other personal bases such as, age, interest in the attractions and

excursion, etc, and adapt the marketing mix to persuade the target market.

5.2.2.3 Positioning

As we mentioned, although medical tourism is rapidly growing around the world, it is known only to a

small group of people in Sweden. To access this market the hospital should target a market niche. In

differentiating its service package, the hospital should position its medical treatment package as one

providing high quality along with Thai hospitality at a reasonable price. RelaxU, its agent in Sweden,

could be aware of a positioning of the Bangkok Hospital Phuket and its target customers to provide the

correct in formation to the right target group and encourage them to be the hospital’s customers.

Moreover, in positioning itself for a leisure group of tourists the company should cooperate with the

tour operators to position a tourism package in an appropriate way for its customers.

5.3 Strategic tourism marketing implementation and control

As we mentioned previously, this paper aims to study the demand of Swedish tourists and to suggest

the appropriate eight Ps to the Bangkok Phuket Hospital. Hence, in this final stage we will illustrate the

sub stage named ‘Implementing the Tourism Marketing Mix’.

We have survey the Swedes’ opinions about Thailand, medical tourism in Thailand and the healthcare

system in Sweden. We have found that most Swedes have a good feeling about the general service

of medical treatment in Sweden and most of them feel okay with the long waiting line. Meanwhile,

although the country faces problems with the long queues for admission to public hospitals, people

still accept it. Moreover, the interest for the medical treatments we offered in the questionnaire is

typically low. This seems to be a challenge for the Bangkok Hospital Phuket to increase its market

share in this market. After the strategic tourism marketing planning stage, we give suggestions for

developing the eight Ps for the Bangkok Hospital Phuket

5.3.1 Product

The hospital is categorized as a service business. Product or customer value from the service

perspective refers to treatment and additional service.

The core service refers to medical treatment. Since we have two segments of customers, leisure

tourists and the specifically medical treatment tourists, we have to offer them the service in different

ways

- The leisure group: According to the information from the empirical part, secondary data

as well as the survey results illustrated that dental treatment is the most favored treatment for Swedes,

along with LASIK. Thus, the hospital should develop dental treatment and eye-care service including


LASIK to persuade prospective customers. In the case of other services such as rejuvenation, for

which there is less demand, is not necessary to develop a service at this time.

- The specifically medical treatment group: The study in empirical part has shown that there

is not much market interest since the Swedish people believe in the quality of health care service in

their home country. They also do not feel confident in quality of medical treatment in Thailand.

However, the hospital should pay attention to this kind of service since it has signed a contract with an

agent in Sweden last year. To develop a service package for this group of customers, the hospital

should do further studies to analyze the causes for this perception of low quality. There is potential

demand from prospective customers for the same treatments offered by the company, such as hip and

knee surgery, because of the long waiting lists for hospital operations in Sweden. It is a tough task

since the company is in the introductory stages of offering the service and has a number of threats to

be concerned with.

However, the high standard of quality is a factor that the company should emphasize, since Swedes

have concerned about quality of treatment and most of them consider the treatment in Sweden to be

of a higher quality than that in Thailand. The survey results showed that having professional and

qualified medical personnel is the most important factor( 57.8% of respondents chose this as the first

rank, see table 24, appendix 5) along with having excellent medical equipment. These survey results

affirm that a high standard of quality is needed. Although the hospital gives good educational support

to its staff and gets hospital accreditation in Thailand, it should also obtain international accreditation,

such as JCIA accreditation, to show the effectiveness of its treatment.

The other facilitating services such as direct correspondence with the doctor (the highest rank, see

table 25, appendix 5) , the reservation system, the payment system, etc. should be emphasized in

order to make the service more convenient. However, we will discuss these factors again in ‘Process’.

The supporting services, such as accommodations (especially for the retired customers) and the

airport pick-up, also influence the demand of customers, especially for the case of repeat visits and

referral prospects.

Furthermore, the tourism package is an element of the medical tourism service as well, especially as a

service offering for the leisure group. Even though the hospital does not provide the whole service by

itself, it is important to select good business partners that will target the market from the same position

as the company.

5.3.2 Price

There are several factors influencing the price of the medical tourism that the hospital has to concern

as follow;

- First, the government involvement in the market is an important factor that the hospital

has to consider since the welfare system in Sweden offers medical treatment free of charge to


Swedish citizens. Although Bangkok Hospital Phuket positions itself to compete with private hospitals

in Sweden, the poor image in health care quality of Thailand should influence the company to have the

public health care providers as indirect competitors.

- The second factor is seasonal demand, that leads to peak and low periods. Since the

services cannot be kept in stock, then the seasonal demand requires demand management pricing to

reduce the bottle-neck of customers in the high season and reduce the fixed costs in the low season.

As mentioned earlier, the high season for Phuket Island is during the period of November to February

during with the number of customers will increase while the low season is September and October,

which is the rainy season. Offering lower treatment prices during this season can help the hospital

gain more customers. However, for the leisure tourists the lower price of a tourism package could

influence the customers more than the price of treatments.

- The third factor is the pricing of separate elements of the tourism product. The impact of

the demand for other components of the tourism product, for instance, the higher cost of

accommodations from November to February, increasing price of airfare because of oil prices, etc.,

may influence the company to reduce the prices in a short period as a sale promotion.

- The fourth factor is the consumers’ behavior regarding price. As we mentioned in the

previous chapter, Swedish tourists spent approximately 774 SEK per day during leisure trips. The

hospital should use the information on Swedish expenditure as a guideline to estimate the price for

each package for the Swedes by cooperation with tour operator. Moreover, from the results of survey,

Swedes do not pay much attention to the cost of treatment since most of them already know that the

cost of living in Thailand is lower than in Sweden. There are slightly different in price attraction

between age groups, the people age between 36 and 65 has more concern in an attractive and

reasonable price for a treatment than other (see table 12). However, the hospital should not use the

price competitive strategy to motivate its customer since it needs to maintain a high standard of

treatment for its patients.

In choosing a price strategy for the specifically medical tourists, the hospital should consider in two

major factors. First, its aims of providing a high standard of quality but lower price when compared to

private hospitals in Sweden should be undertaken. Second, the necessity of high marketing

communication since the service is in the introductory stage and the Swedes have less interest in this

kind of service in Thailand. The hospital should use lower price than private hospital in Sweden and

high promotion strategy for its medical treatment, which is called rapid-penetration strategy. Moreover,

the hospital should provide its services with a package price, including all kinds of charges since it can

help customer to compare the price with other hospitals before making a decision. The treatment

package price can also help the customer to plan their budget before traveling.

For the leisure tourists, a medical treatment is one of the activities that the tour operators provide to

their customers. Thus, the price list of medical treatments should be offered tourism suppliers since

they are the costs of tourism package in the aspect of tour operators. The hospital may offer a

discount in low season to help them encourage their clients. In case of the additional treatment that


the customers may demand when they experience a good service offering, a price list that the hospital

provides could be in Swedish Krona.

Additionally, from a service perspective the price is a cost to customers. Although the hospital cannot

control the prices of the other additional services, it is necessary to organize things within its business

network, especially for accommodations and excursion services, so that its customers can be

informed. Since the hospital is located very far from Sweden, it is inconvenient for medical tourists to

collect the information.

5.3.3 Place

Place in the service context refers to the convenience of services the medical tourism suppliers

provide. As illustrated in an earlier chapter, the supply chain for the medical tourists starts before

traveling by joining with the interacting facilities, for instance, searching for information, consulting on-

line, making reservations, traveling, etc. While getting treatment at the hospital the customers should

feel convenience when interacting with the hospital staff and other physical environments. Detaching

from the service process, the customers should be impressed with all the comforts and hospitality of

the hospital and accommodation’s staff.

Thus, the hospital has to be concerned with all of the factors from a place perspective that can affect

its business. RelaxU is one of the channels of distribution that the specifically medical tourists can get

information and interact with, before getting the medical treatments. Although this agent has its own

marketing function, the Bangkok Hospital Phuket has to follow up the marketing activities of its agent

to ensure that the service offering of the RelaxU meets the customers’ satisfactions. The

conveniences of tourism packages include simple treatments, which target the leisure tourist should

be taken consideration as well. The channels of distribution such as the Phuket Health and Travel

website should be assessed and developed dynamically, to ensure that the prospects conveniently

perceive services. The services distributed through other tour operators such as the Royal Orchid

Holiday should be monitored and adapted if they are not interesting enough.

Moreover, the distance of Thailand and Sweden should be concerned as it is far from Sweden.

Therefore, the hospital should provide an interesting package that included additional services, which

can make the customer feel that receiving a medical tourism package in Thailand is worthwhile.

5.3.4 Promotion

Promotion refers to the activities used to communicate the product or service and its merits to target

customers and to persuade them to buy. Promotion from the service aspect means communication to

the customers. As the medical tourism is in the introductory stage in Sweden, promotion plays an

important role in encouraging people to learn more about medical tourism, the country’s image of the

quality of health care and the hospital itself.


� Medias

As the results of our survey, the internet is a major source of information (41.0%); along with word of

mouths (26.5%) from their people they know, for instance, friends, colleagues, relatives and other

experienced people; and travel brochures. Thus, the hospital has to pay attention, so that its website

should be interesting, easy to understand and has enough information for the customers. The

hospital’s website could be a good media for both segments and the Phuket Health and Travel

website could penetrate the leisure tourists. Moreover, the hospital should cooperate with tour

operators or any organizations in Sweden that can help to distribute its brochures since it is a source,

which can influence the customer’s decision-making, according to our survey’s results.

In addition, an interesting activity that the hospital should use to promote its business for Swedes is

the familiarization and site inspection trip or ‘Fam trip’. According to Ms Veena Panjamanond Bohlin,

the trip allows journalists to gain experience in Thailand. After the journalists’ visit, publication could be

used to distribute the journalists’ impressions. As we found that medical tourism is in the introductory

stage, the hospital has to make itself to well known in this market as much as possible. Therefore,

marketing public relations from third persons such as Swedish journalists is an interesting way to allow

its business to be recognized by the Swedes. Moreover, the hospital should cooperate more with the

TAT Stockholm to promote itself since TAT Stockholm is pleased to help any organizations and any

projects that persuade foreigners to go to Thailand. Therefore, the hospital can have more activities

for promotion through TAT Stockholm.

� Messages

Language is definitely a major concern for marketing communication since the English language is not

the official language of Sweden and from our experience while distributing a questionnaire, there are

many Swedes that are not fluent in English, especially the elderly. Therefore, the hospital has to make

sure that it promotes itself well in the Swedish language for the Swedes. Furthermore, the hospital’s

website and its medical tourism website could provide the information with plain language in which

clear and effective communication and could be ensure that there are not over promise since these

external communications should encourage the prospects’ expectation in services quality.

Although the two target groups consume the different kinds of medical treatments, the same message

of: ‘high service quality along with Thai hospitality at a reasonable price’ could be used. Even though

the RelaxU plays important role in marketing communication in Sweden, direct messages from the

hospital through brochures, the internets and other types of media should consider the Swedish

culture, their life style and traveling behavior.

Since word of mouth is the unplanned message with the most credibility, high quality treatment and a

good impression of additional services should provide the hospital with a good image and positive

word of mouth. This can be the best advertisement and a big influence for selecting treatment at the

Bangkok Hospital Phuket.


However, marketing promotion has costs as well. In case of planned messages, the hospital has to

evaluate the cost effectiveness of each project before making a decision.

5.3.5 People

People means all of the participants who play a part in service delivery and influence the customer’s

perception including contact employees, the customer him/herself, and other customers in the service

environment. Therefore, the people in this case refer to visitors or tourists, the employees of tourism

organizations, and the staff of hospitals including doctors, nurses and all contact personnel.

The questionnaires’ results show that the first rank of the additional services before and after

treatments that Swedes are concerned with is correspondence with the doctor (62.8%). Therefore, the

doctor is the most important person that should correspond with them.

According to the survey, the first rank of important factors for medical treatment is having professional

and qualified medical personnel (57.8%); therefore, the hospital has to have the professional medical

personnel including doctors, nurses, and pharmacists to take care of the patients.

Moreover, the Swedish interpreters also important since the Swedish people do not use English as an

official language. Although the Swedish language is not the most important factor in medical treatment

as illustrated in Figure 21 and Table 24 of the survey results. In our opinions, communication with their

own language could make patients feel convenience while taking a patient history, and make more

confident to get medication. Therefore, the interpreter is important contact personnel that the hospital

has to take into consideration.

In addition, the hospital should position itself in the market with Thai hospitality, which includes

service-mindedness and politeness. Not only technical skills but also human relationship skills and

international language should be trained to its entire staff.

In case of other people who interact with its customers, especially the leisure tourists, who have more

interaction outside the hospital than the specifically medical treatment tourists. Although the hospital

cannot control these people, it should ensure that the selected tour operators and other businesses

cooperators also provide their services with the contact personnel who have a good Thai hospitality

and service mind.

5.3.6 Process

Since the hospital is the service provider, the service process should be a high consideration. In

addition, the quality of the interaction process; for instance, consultation, reservations, booking,

treatment, travel, and payment, need to be taken into consideration systematically.


As we mentioned previously, the internet is the favorite source of information. Although the hospital

provides its own website and has a specific website for medical tourism with a number of foreign

languages, including Swedish, the websites need to be updated and made to be accessed more

quickly. Correspondence with the doctors before getting treatment is also a major factor that the

hospital should emphasize. Promptly replying to mail when the prospects ask for more information is

also important since it will bring a good image of the service mind. RelaxU, the agent in Stockholm is

also in contact with the customers during the joining process before they make decision. Thus, the

hospital has to keep in close contact with its partner to make sure that they are following the same

policy while doing business.

It is also important to have a well-organized process before traveling, which includes getting airplane

tickets, flight reservations and accommodations, and applying for a visa in case of trips lasting longer

than thirty days. Although these activities are not taken care of by the hospital, supplying information

through the web links would provide convenience to the customers during the joining process.

Moreover, the hospital should provide good support for the process on arrival and departure day such

as transferring between Phuket International Airport and the hotel, especially the specifically medical

treatment tourists.

In the interaction process, not only the good quality of treatment and nursing care, but also other

supporting services such as the first appointment with the doctor, the admission, the hospital’s

restaurant, the favorite meals of in-patient customers, communication facilities to the customer’s

hometown, etc. should be of concern. However, the company faces the threat that from the Swedish

customers’ point of view, the quality of treatment in Thailand is relatively low when compared with their

home country. Thus, the hospital should supply great care during treatment to improve the customers’

perception.

In the discharging process, the payment system also has to be developed, to make it convenient for

the customer for instant the currency of payment should be convert to Swedish krona. A transferring

system and follow-up process should also be prepared. Coordination with the tour operator to supply

excursion activities is also important to make customer feel satisfied with the service, which leads to

good word of mouth.

5.3.7 Physical evidences

As in the service perspective, customers are also involved in the service process and they have

contact with the personnel and physical resources of the service provider.

The environment’s surroundings for the treatment service; for instance, the medical personnel and

staff’s appearance, medical equipment, the interior and exterior of the buildings, recuperation rooms,

etc should have a good physical appearance. The hospital should also have high technological

equipment as it is committed to service with a high quality standard.


Moreover, the service’s surroundings in the additional services; for example, accommodations,

airlines, and hotels should also have a good physical appearance. Though the hospital cannot control

this kind of evidences since they are provided by the other organizations in the tourism network, the

hospital can have a preventive process by selecting the good partners at the beginning.

Additionally, the tourism package should also be taken into consideration. Good attractions and

excursions should provide good physical evidence to make the customer impressed.

5.3.8 Partnership

In the tourism perspective, partnership is a factor that added into the marketing mix. It refers to the

organizations in the business network. As we can see there are many organizations related to the

medical tourism supply chain.

The partnerships of Bangkok Hospital Phuket for medical tourism package include those with tour

operators, travel agents, RelaxU, airlines, hotels, and internet providers, etc. Since medical tourism is

a fragmented industry, it is not easy to manage its own trips for medical tourists. Choosing good and

cooperative partners is very important.

For the leisure tourists, the main purpose of them is traveling but they will get treatment as an

additional service. In this case, the hospital does not need to cooperate with RelaxU, which is an

agent for the patient who needs to get the medical treatment in another country. The tour operator

plays an important role instead.

In case of specifically medical tourist, the customer focus is on the treatment since the main purpose

of the trip is to receive treatment but they will get a tourism package as an additional service during

their recuperation period. In this case, the hospital has to cooperate with RelaxU since it is the main

organization, which arranges all of the processes for the patient. However, the dependent relationship

may cause a high risk if they end the connection. Thus, the Bangkok Hospital Phuket should look for

other partners to ensure that it does not rely on a single source.


6 Conclusion & Recommendation

After the assessment and analysis of the empirical finding, we have come to the point to give the

conclusion and recommendation. We draw conclusion based on theories and reality and will connect

them with the answers on the main and sub-questions of our research.

6.1 Conclusion

The Royal Thai government is promoting the country to be a health care hub of Asia. This policy will

influence medical tourism in Thailand to grow rapidly. However, in case of the Bangkok Hospital

Phuket, the management believes that the government is providing inadequate support. Phuket is the

largest Island in southern part of Thailand. It was promoted by the Thai government to be a health

care hub along with Bangkok, Chaingmai, and Samui. Additionally, Phuket is the favorite destination

of Swedish people as well. There are two international standard hospitals in Phuket, Bangkok Hospital

Phuket and Phuket International Hospital. The Bangkok Hospital Phuket is one of the private hospitals

that aims to play a part in the medical tourism business.

Sweden is a country which is ranked as the top leading nation in healthcare. However, the country

faces with the problem of long waiting times for hospital admission. In contrast, the survey results of

400 respondents in the cities of Stockholm and Västerås illustrate that almost of the Swedes feel okay

with their local waiting list. In studying the opinions of Swedish people about Thailand, we found that

they are likely to have a vacation at the destination where there is sea, sun and beach. Phuket is also

a favorite destination. The survey results illustrated that Phuket is the second favorite destination.

However, in case of medical treatment provided by a private hospital in Thailand, the Swedish people

have a little interest since medical treatment is free of charge when performed at a public hospital in

their own country. Besides, from the Swedes’ point of view the Swedish health care system has higher

quality than that in Thailand.

Bangkok Hospital Phuket is interested in the Swedish market for medical tourism business, which is a

new trend for tourism businesses in Thailand. The company prepared itself to be a tourism medical

service supplier by investing in a new building and it has signed a contract with RelaxU in Stockholm,

Sweden, as its agent for medical tourism service last year. It also provides a website, named ‘Phuket

Health and Travel’ to communicate with the potential customers. The Bangkok Hospital Phuket has

also built a good relationship with Lund University in Sweden for personnel development support.

Additionally, it has a good image among Swedish people from helping the tsunami victims.

In doing the situational analysis, we found that Bangkok Hospital Phuket has a number of strengths

that make it well-prepared to compete in the medical tourism industry. However, the company also has

some weaknesses to resolve; especially the risk from having a single source partner and the mistake

of not following up on its marketing plan. The major threat of the company comes from the Swedish


misperception of medical tourism in Thailand. From the SWOT analysis, we found that the hospital

has more strengths than weaknesses and more threats than opportunities; therefore, it should use the

S-T strategy.

Although, the survey results showed the Swedes have less interest in this kind of business, the

commitment of the management and its high potential to provide the inbound medical treatment

encourage us to go on to the stage of strategic tourism marketing planning. The marketing segment

should be divided into two groups: the leisure tourist who comes primarily for leisure and includes a

check-up or a simple procedure during his or her holiday, and the specifically medical treatment

tourists, whose destination is the hospital. We offer to apply the selective specialization pattern to

persuade its targets. The leisure tourists aim to take a longer vacation and receive simple procedures

in a medical package that does not take a long time for treatment and recuperation. In contrast, the

specifically medical treatment tourists aim to have a specific treatment at the hospital directly and

spend a couple of days for leisure time. However, the company should target a market niche, to

differentiate its service package, to position its services as being of a high quality along with Thai

hospitality at a reasonable price.

In the stage of strategic tourism marketing implementation and control, we suggest the company

should develop its marketing mix for these two target groups. According to the survey results, the

highlight treatment is dental treatment, which has the highest mean of interest, followed by LASIK. The

hospital should offer differentiated services to each segment with the same standards. However, we

think that the leisure tourists should be easier to access. We suggest that the company adopt a rapid

penetration price while being aware of the factors that can influence the price of the tourism product.

The place as being convenient to the customer should be of concern. In case of marketing

communication, the internet is the most favored source of information. Hence, the company should

have a dynamic development and up-to-date websites. Participating in a series of familiarization and

site inspection trips or FAM trips, of the Tourism Authority of Thailand, Stockholm is one kind of

communication that we suggest. The promotion should be interesting for each target while considering

language. Moreover, people, process and physical evidence should be have a good appearance and

be well organized and professional. Furthermore, the partnerships of the business should be taken

into consideration since there are several organizations involved in the medical tourism process.

Additionally, correspondence with the doctor is a necessary facilitating service to persuade potential

customers. The other supporting services that the hospital cannot omit include accommodations,

internet accessibility and Thai hospitality for the customer. After perceiving the medical treatment and

discharge, a good impression from the high quality services and Thai hospitality could give the

customer a perception of service satisfaction, and promote good word of mouth to the other prospects


6.2 Recommendations

Although Thailand is a good destination from the Swedes’ point of view, the demand of medical

tourism in Sweden is not very great. To encourage the demand of Swedes for medical tourism,

investment in fixed assets, technology equipment, and high quality human resources are inadequate.

The major problem to increase its market share is not from the supply side. The Bangkok Hospital

Phuket has to communicate with the potential customers to inspire trust in them to be a medical

tourist, in Thailand, especially in Phuket, where the hospital located.

6.2.1 Recommendations for the hospital

The marketing communications could be a good strategy to penetrate the market in a short-run period.

Supporting the familiarization and site inspection trips with Tourism Authority of Thailand, Stockholm,

should be the cheapest way. Since the company could sponsor the journalists to visit Phuket and have

a study visit at the hospital or joining some leisure trips of medical tourism; for example, dental care,

eye check up, eyeglass fitting along with excursion packages such as snorkeling, golfing, etc. A

positive recommendation in an article would be a good public relations feedback that would allow the

Swedish people to know more about the hospital. In a long-run period, the hospital may establish a

good connection with medical stakeholder in Sweden such as universities, hospitals, state healthcare

institutions, to build trustworthiness among the Swedish patients.

Medical tourism has a number of service suppliers to make contact with. The hospital has to establish

good relationships with other members in the business network, especially, tourism promoters such as

TAT and tour operators. The tourism suppliers, for example hotels and airlines are also important

since they can support a good trip with an attractive price.

According to our research results, the leisure tourist is the most interested group since Swedes would

feel free to join the package at less risk, when compared with surgery that they do not have trust in,

from Thai medical service providers at the present time. Although this kind of package generates less

income with each treatment, the repeat visits and the good word of mouth will help the hospital to gain

more patients and a positive image.

The serious problem treatment services may not suitable in the short term. Marketing feasibility

studies could be done by professionals before making this decision. The Swedish people were too shy

and did not show much cooperation in answering the questionnaire. Moreover, this potential segment

contains people who face the problem of long queues. The focus group interview should be a proper

method to study their demand.

Reducing the risk of a single source partner, the hospital should build the relationship with other

organizers.


6.2.2 Further research

In this research, we found that the collaborations for medical tourism are very important since the

hospital has a major function in treatment and it has to cooperate with other tourism promoters and

tourism suppliers. Therefore, we suggest that the hospital should study the tourism business network,

especially for the leisure medical tourism, for further research. In addition, the results of survey

research illustrate that the Swedish people have little interest in medical treatment in Thailand

although they face in long waiting lists for local public hospital operations. To study the demand of

these specific medical treatments, interactive focus group research should be conducted, especially

research on patients of private hospital in Sweden.


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Sun, sand, surf and surgery in Thailand a

Appendices

Appendix 1 Information of Bangkok Hospital Phuket

Financial Highlight of Bangkok Dusit Medical Service Public Company Limited

(In million Baht)

2006 2005 2004 2003 2002 31/03/06 31/12/05 31/12/04 31/12/03 31/12/02

Assets 19,979.57 17,677.20 14,598.37 7,304.92 5,669.62

Liabilities 11,569.18 9,259.67 6,710.96 3,579.48 2,500.60

Equity 8,176.99 7,889.60 7,525.03 3,384.38 3,136.60

Paid-up Capital 1,181.04 1,163.41 1,163.41 750 750

Revenue 3,523.76 10,723.73 5,635.33 3,313.99 2,578.97

Net Profit 353.76 832.11 623.15 384.47 241.61

EPS(Baht) 0.3 0.72 0.71 5.13 3.79

ROA(%)* 8.77 8.32 7.87 8.98 8.42

ROE(%)* 11.86 10.8 11.42 11.79 8.74

Net Profit Margin(%) 10.04 7.76 11.06 11.6 9.37

Source: The Stock Exchange of Thailand 2006

(In US$ Thousand)

2006 2005 2004 2003 2002 31/03/06 31/12/05 31/12/04 31/12/03 31/12/02

Assets 499,489.25 441,930.00 364,959.25 182,623.00 141,740.50

Liabilities 289,229.50 231,491.75 167,774.00 89,487.00 62,515.00

Equity 204,424.75 197,240.00 188,125.75 84,609.50 78,415.00

Paid-up Capital 29,526.00 29,085.25 29,085.25 18,750.00 18,750.00

Revenue 88,094.00 268,093.25 140,883.25 82,849.75 64,474.25

Net Profit 8,844.00 20,802.75 15,578.75 9,611.75 6,040.25

Source: Adapted from the Stock Exchange of Thailand 2006(calculate as US$ 1 = THB 40)

Sun, sand, surf and surgery in Thailand b

Organization chart of Bangkok Hospital Phuket

Source: Bangkok Hospital Phuket 2006

Sun, sand, surf and surgery in Thailand c

Multi-Lingual coordinator team of Bangkok Hospital Phuket

Name Specialty

Mr. Aekupsorn English / Russian

Mr. Andrea English / Italian / French

Miss Angela English / Scandinavian

Miss Fatima English / Filipino

Miss. Hiroko English / Japanese

Mr. Kennerth English / Scandinavian

Miss Manusnum English / German

Miss. Pornacha English

Mr. Savanai English

Ms. Theresa English / Filipino

Mr. Werner English / Dutch / French / German

Source: Bangkok Hospital Phuket 2006d

Scandinavian insurance coordinating with Bangkok Hospital Phuket

Company Telephone

INTERNATIONAL HEALTH INSURANCE A/S (IHI) – Denmark

+45 33 15 30 99

NORDIC INTERNATIONAL ASSISTANCE - Denmark

+45 70 20 21 71

KOMPAS REJSEFORSIKRING A/S – Denmark.

+45 44 68 8200

GOUDA REJSEFORSIKRING +45 33 15 60 60

DEN NORSKE BANK - Norway. +47 22 48 10 50 +47 800 81 030 +47 66 98 06 40

Source: Bangkok Hospital Phuket 2006k

Sun, sand, surf and surgery in Thailand d

Appendix 2 Questionnaires

Questionnaire in English Hi!

We are master’s students at Mälardalen University, Västerås doing our Master Thesis. We are

surveying the opinions of Swedish people concerning medical tourism in Thailand (obtaining medical,

dental and surgical care while on holiday). Medical tourists can also experience Thailand after their

treatment(s).

Your opinion is extremely important for us. Thank you for taking a moment to answer the following

questions:

General information Please kindly give us our personal information

1. Age

� Below 18 � 18-35 � 36-65 � Over 65

2. Gender

�Male �Female

3. Marital status

�Married/Living with partner �Separated/Divorced

�Widowed �Single

4. Occupation

�Government employee �Trade and industry employee �Self-employed

�Student �Housewife / Househusband �Others

5. Children younger than 18 living in the household _________

6. Education Background

� Nine-year compulsory school � Upper secondary school � University/university college

degree

Opinion about Thailand

1. Please give your opinion about Thailand

�I have been there. �I would like to visit.

�I have just heard about this country �Other (please specify)…………………………

2. Please select the destination in Thailand that you like most

�Bangkok �Phuket �Chiang Mai �Koh Samui �Other

Medical service in Sweden

3. Please rate the service provided at your local hospital in general.

�Very Good �Good �Okay �Fair �Poor

Sun, sand, surf and surgery in Thailand e

4. Please rate the service provided of your local hospital regarding the waiting line in a case of serious health problem.

�Very Good �Good �Okay �Fair �Poor

5. If you would have troubles getting treatment at your local hospital, you would consider healthcare providers abroad.

�Strongly agree

�Agree

�Neither agree nor disagree

�Disagree

�Strongly disagree

6. You feel worried that you might have to wait for a long time before getting hospital admission in

Sweden.

�Strongly agree

�Agree

�Neither agree nor disagree

�Disagree

�Strongly disagree

Service package of medical tourism

7. Please rank the sources of your destination selection if you want to traveling abroad ( Please rank

1-8, 1 means the most favorite)

............... Friends/relative./colleague/experienced person

............... Internet

............... Travel Brochure/ Guidebook

............... Newspaper/Magazine

............... Travel Agency

............... TV travel program

............... Tourist boards

............... Previous Visit

8. Please rank the important factors in your opinion if you want to receive a medical treatment ( rank

1-8, 1 means the most important)

............... Large spectrum of different treatment

............... Excellent medical equipment

............... Professional and qualified medical personnel

............... Hospitable of a hospital’s staff

............... Attractive and reasonable prices for treatment

............... International Accreditation

............... An interpreter and information in Swedish

............... An interpreter and information in English

9. Please rank the supporting services you want before and after your treatment ( rank 1-7, 1 means

the most important)

............... Flight reservation

............... Accommodation service

............... Correspondence with the doctor

............... Transfer between airport, hotel and hospital

............... Tourism package

............... Online consulting service

............... Follow up visit

Sun, sand, surf and surgery in Thailand f

10. Please rate the medical treatments you are interested if you visit Thailand

(5 means the highest interested and 1 means the lowest interest) Degree of interested Medical Treatments

5 4 3 2 1 Annual check-ups Dental treatment LASIK MRI scanning Rejuvenation treatments Plastic surgery Hip or knee replacements Urgent treatment

Thank you very much for your assistance!

Questionnaire in Swedish

Hej,

Vi är studenter på Mälardalens Högskola i Västerås som gör vårt examensarbete. Vi undersöker

svenskarnas uppfattning om att resa utomlands till Thailand för att få läkar- och tandvård samt

plastikkirurgi medan de är på semester. Patienterna kan även uppleva Thailand efter avslutad

behandling.

Din åsikt är väldigt viktig för oss. Tack för att du tog din tid för att svara på följande frågor:

Allmänna frågor: Var god svara på de följande frågorna:

1. Ålder

� Under 18 � 18-35 � 36-65 � Över 65

2. Kön

�Man �Kvinna

3. Civilstånd

�Gift/sambo �Frånskild

�Änka/änkling �Singel

4. Sysselsättning

�Anställd av kommunen/staten �Privatanställd �Självanställd

�Student �Hemmafru / Hemmaman �Övrigt

5. Antal barn yngre än 18 år som finns i hushållet _______

6. Utbildningsbakgrund

�Grundskola �Gymnasium �Högskole- eller Universitetsexamen

Sun, sand, surf and surgery in Thailand g

Åsikter om Thailand

1. Var god ange din åsikt om Thailand

�Jag har resat dit. �Jag skulle vilja resa dit.

�Jag har hört om andras resor ditåt �Övrigt (skriv)…………………………

2. Vart vill du mest resa till i Thailand?

�Bangkok �Phuket �Chiang Mai

�Koh Samui �Annat

Läkar-/tandvård i Sverige

3. Vad tycker du om vårdkvalitén hos ditt lokala sjukhus?

�Väldigt bra �Bra �Okej �Inte så bra �Dålig

4. Värdera servicen hos ditt lokala sjukhus när det gäller väntan på akutvård.

�Väldigt bra �Bra �Okej �Inte så bra �Dålig

5. Om du skulle få problem att få vård på ditt lokala sjukhus, skulle du kunna överväga att söka vårdgivare utomlands.

�Instämmer starkt

�Instämmer

�Ingen åsikt �Instämmer

inte �Instämmer

starkt inte

6. Du känner dig orolig för att behöva vänta länge på läkarvård i Sverige..

� Instämmer starkt

� Instämmer

� Ingen åsikt � Instämmer

inte � Instämmer

starkt inte

Servicer under din resa

7. Hur brukar du söka information om resemål ifall du skulle åka utomland? (skriv 1-8, där etta är den

vanligaste i listan)

............... Vänner/släktingar/arbetskamrater/folk som har rest utomland

............... Internet

............... Rese broschyrer/böcker

............... Tidningar/tidskrifter

............... Turistbyrå

............... Reseprogram på teven

............... Turists webbsida

............... Tidigare besök

8. Vilka faktorer som du tycker att det är viktig när det gäller att få läkar-/tandvård utomlands (skriv

1-8,

där 1 är den viktigaste i listan)

............... Många olika behandlingsmetoder

............... Utrustning av hög kvalité

............... Professionell och kvalificerad vårdpersonal (läkare)

............... Vänlig personal (sköterskor)

............... Bra pris

............... Internationellt ackrediterade (godkända / erkända)

............... Tolk och/eller information på svenska

............... Tolk och/eller information på engelska

Sun, sand, surf and surgery in Thailand h

9. Vilka service som du skulle vilja få före och efter din behandling (skriv 1-7, där 1 är den viktigaste i

listan)

............... Flygbiljettsbeställning

............... Logi

............... Kontakt med läkaren, före och efter resan

............... Transport mellan flygplatsen och ändemål (hotell, sjukhus, m.fl.)

............... Resepaket som ingår

............... Konsultation via nätet

............... Återbesök

10. Var god värdera de olika behandlingar som du skulle ha intresse på om du åkte till Thailand för att

få läkar-/tandvård:

(Femma betyder mest intresse) Intresse Behandlingar

5 4 3 2 1 Årlig läkarundersökning Tandvård LASIK (Ögonlaser) MRI (Hjärnscanning) Skönhetsbehandling (Hud och/Fettsugning) Plastik kirurgi Höft-/knäledsbyte Akutvård

Tack så mycket för din hjälp!

Data encoded in Excel file

Sun, sand, surf and surgery in Thailand i

Appendix 3 Interview questions

Interview questions for the management of Bangkok Hospital Phuket

o Interview with Dr. Kongkiat Kespechara, Hospital Director and Dr. Sompoch Nipakanont, Assistant Hospital Director by telephone on 21Apr, 2006 at 7.00 – 8.30 a.m in Sweden

1. Medical tourism policy

1.1. Service policy for foreign patients - Does the company segment the normal foreign patients and medical tourist patients

separately? How?

1.2. Medical tourism service policy - Could you please inform us the marketing policy of medical tourism? - Who are the target group of the medical tourism services, provided by the company? Why? - Please give us the strength of medical treatments services of the company, when compare

with other hospital, other countries? - Since medical tourists are patients from other countries, does the company have the

business network or business alliance? - How does the company manage the service package, as following:

o Determine the medical tourism service package o Booking system o Initial prescribe before admission o Accommodation for patients o Follow up checking

1.3. The policy for Swedish patients - Does the company have special policy to take care of Swedish patients? Why? How? - Does the company have partner or alliance in Sweden?

1.4. How can the hospitals in Bangkok Hospital group coordinate in case of patients transfer?

2. Management policy

2.1. What are the essential equipment that the company has to invest to prepare for the international market?

2.2. What should the location, building, ward, and other facilitated services be prepared?

2.3. How can the company prepare the HRM, especially to rival in the medical tourism market?

2.4. Could you please give us the corporate social responsibility policy?

3. Performance

3.1. What is the major nationality of international patient?

3.2. Could you please rate the ration between normal patients and medical tourists patients?

3.3. Does the company record the statistics of international patients?

3.4. When is a high season of medical tourism?

3.5. In your opinion, the long stay tourism, promoted by the Royal Thai government, influence the medical tourism or not?

3.6. What are the core medical treatment packages that are the highlight of Bangkok Hospital Phuket? Why?

Sun, sand, surf and surgery in Thailand j

o Interview with Mr Pakin Ruktae-ngam, Marketing manager by telephone on May 4, 2006 at 6.00-7.00 a.m. in Sweden

1. What is the Swedish insurance that Bangkok Hospital Phuket has to deal with?

2. What is the process for the hospital working with Relax U?

3. How does the patient consult with the doctor before treatment?

4. How does the company transfer patient’s medical record?

5. What are cases that Relax U sent to the hospital?

6. How does the hospital calculate patient’s expense?

7. What kind of currencies the customer can pay to Relax U?

8. How does the hospital calculate cost of package? Does the company charge the customer in all package or separate payment of treatment and tourism package?

9. What are things the company includes to charge the customer?

10. Does the company estimate the other expenses such as accommodation for the patient?

11. What is the process of payment for medical tourism package if the customer has contact in both Phuket Health& Travel and Relax U?

12. What kind of currencies the customer can pay to the Bangkok Hospital Phuket?

13. Do the customers need to pay deposit before treatment?

14. Does Relax U charge more money if the customer contact though Relax U?

15. Does the hospital provide the package tour or has cooperate with the tour operator for dental treatment, check-up, eye check-up for the tourist?

Interview questions for the management of Tourism Authority of Thailand, Stockholm office

o Face-to-face interview with Ms. Runjuan Tongrut, Assistant Director on April 18, 2006 at 10.10-11.00 am ( Drottninggatan 33, 111 51 Stockholm, Sweden )

1. Could you please give us the roles of TAT, Stockholm to promote Thailand, especially in medical tourism?

2. Who are the target group of TAT, Stockholm, to promote Thailand?

3. Where is the favorite destination of Swedish people in your opinion?

4. What are the partners that TAT, Stockholm, work with, to promote Thailand?

5. May we distribute the questionnaire at TAT, Stockholm?

Sun, sand, surf and surgery in Thailand k

o Interview with Mrs. Veena Panjamanond Bohlin, Marketing Manager by telephone on May 3, 2006 at 4.30 – 5.00 p.m

1. Where are the favorite destinations of Swedish people when they visit Thailand?

2. What type of tourism package that the Swedish like most?

3. What are the business networks of TAT in Sweden to promote Thailand? How do you work with them?

4. Could you please inform us what are the roles of TAT Stockholm to promote the medical tourism in Thailand?

5. How do you support the medical tourism project of Bangkok hospital Phuket?

6. Could you please give us the suggestions of medical tourism for Swedish tourists?

7. Please give us your opinion and reasons, what medical tourism package is suitable for this target group (The package for leisure tourists, who incorporates a visit to the doctor for some minor treatment or a specific package for medical treatment)

Thank you for your kindly cooperation.

The interview question of Swedish experts in healthcare system

1. In your opinion, what are the most serious problems currently facing the Swedish healthcare system?

2. In your opinion, do you think that the average Swedish patient has to wait longer than should be expected for state-funded medical treatment and operations?

3. Do you agree or disagree with the idea of medical tourism? For example, should medical tourism be encouraged or discouraged as a way of receiving higher quality or expedited medical treatment?

4. If the Thai government promotes Thailand to be Asia’s healthcare hub, what do you think would be the major factors that would influence Swedish people in making a decision to travel and have a medical treatment to the country?

5. Do you know of Bangkok Hospital Phuket? If yes, please give your opinion about this hospital since it provides medical treatments to Swedish tourists.

6. Do you know RelaxU Sverige? Do you agree with the idea to promote Swedish patients to have a medical treatment abroad? Please give your reasons to support your opinion.

7. What do you think the future will be for medical tourism amongst Swedish tourists?

8. How do you think that the continued increase in medical tourism will affect the healthcare industry in Sweden?

Sun, sand, surf and surgery in Thailand l

Appendix 4 Interviewees’ list

Bangkok Hospital Phuket

Name Dr. Kongkiat Kespechara Position Hospital Director E-mail [email protected] [email protected] Telephone +667 625 4425

Name Dr. Sompoch Nipakanont Position Assistant Hospital Director E-mail [email protected] Telephone +667 625 4425

Name Mr. Pakin Ruktae-ngam Position Marketing Manager

E-mail [email protected] Telephone +6697294667, +6617879421

Name Pol. Col. Dr. Sopon Krisanarungson Position Director of Heart Center E-mail [email protected] Telephone +661 818 2517

Tourism Authority of Thailand, Stockholm office

Name Ms Runjuan Tongrut Position Assistant Director E-mail [email protected] Telephone +46(0) 8 700 56 95

Name Mrs. Veena Panjamanond Bohlin Position Marketing Manager, Scandinavia & Finland E-mail [email protected] Telephone +46(0) 8 700 56 96

Karolinska Instutet (KI), IHCAR(International Health)

Name Prof Hans Rosling Position Professor, Forskare E-mail [email protected] Telephone +46(0)8517 76 498

Name Lennart Bogg Position Doctor, Forskare E-mail [email protected] Telephone +46(0)8524 833 78

Department or Caring and Public Health Sciences, Mälardalen University

Name Roland Svensson Position Professor , Head of department E-mail [email protected] Telephone +46(0)-216-153737

Sun, sand, surf and surgery in Thailand m

Appendix 5 The survey results

Table 15 Marital status of the respondents

Marital status No % Married/Living with partner

173 43.3

Separated/Divorced 20 5.0

Widowed 5 1.2

Single 202 50.5

Total 400 100.0

Table 16 Occupation of the respondents

Occupation No % Government employee 56 14.0 Trade and industry employee 77 19.2

Self-employed 24 6.0

Student 217 54.2

Housewife/Househusband 3 0.8

Others 23 5.8

Total 400 100.0

Table 17 Educational background of the respondents

Educational background No %

Nine-year compulsory school 47 11.7

Upper secondary school 206 51.5

University/university college degree 147 36.8

Total 400 100.0

Table 18 Number of children younger than 18 living in the household

No of Children No %

0 299 74.8

1 52 13.0

2 30 7.5

3 14 3.5

more than 3 5 1.2

Total 400 100.0

Table 19 The favorite destination in Thailand

Destination Frequency Percent Bangkok 110 27.5 Phuket 102 25.5 Chiang Mai 16 4.0 Koh Samui 56 14.0 Other 116 29.0 Total 400 100.0

Table 20 Healthcare abroad consideration and worry of waiting for admission

Considering of healthcare

providers abroad Feel worry to wait for long time

Opinions No %

% Cumulative

No % %

Cumulative Strongly agree 34 8.5 8.5 19 4.8 4.8

Agree 159 39.8 48.3 138 34.5 39.3

Neither 117 29.2 77.5 113 28.2 67.5

Disagree 68 17.0 94.5 117 29.2 96.8

Strongly disagree 22 5.5 100.0 13 3.3 100.0

Total 400 100.0 400 100.0

Sun, sand, surf and surgery in Thailand n

Table 21 Opinions in healthcare abroad

Percent consideration to get treatment abroad Age Educational Background Strongly

Agree Agree Neither Disagree

Strongly

Disagree Total (%)

Nine-year compulsory school 2.6 25.6 25.6 53.8

Upper secondary school 25.6 12.9 7.7 46.2 Below 18

Total 2.6 51.2 38.5 7.7 100.0

Nine-year compulsory school 0.8 0.4 1.9 1.2 4.3 Upper secondary school 4.3 21.4 16.0 9.7 3.8 55.2 University/university college degree 3.9 16.3 10.9 7.8 1.6 40.5

18-36

Total 9.0 38.1 28.8 18.7 5.4 100.0 Nine-year compulsory school 2.1 3.2 6.3 2.1 13.7 Upper secondary school 4.2 20.0 11.6 8.4 2.1 46.3 University/university college degree 2.1 18.9 9.5 7.4 2.1 40.0

36-65

Total 8.4 42.1 27.4 17.9 4.2 100.0 Nine-year compulsory school 22.2 22.2 Upper secondary school 11.1 11.1 22.2 University/university college degree 22.3 11.1 22.2 55.6

Over 65

Total 22.3 11.1 22.2 33.3 11.1 100.0

Table 22 The sources of information for choosing the destination

the first rank the second rank the third rank Sources of information No. % No. % No. %

Friends/relative./colleague/experienced person 126 31.5 96 24.0 62 15.5 Internet 173 43.2 95 23.8 46 11.5 Travel Brochure/ Guidebook 35 8.8 85 21.2 80 20.0 Newspaper/Magazine 9 2.3 38 9.5 61 15.2 Travel Agency 20 5.0 24 6.0 49 12.2 TV travel program 6 1.5 16 3.9 42 10.5 Tourist boards 9 2.2 15 3.8 29 7.3 Previous Visit 22 5.5 31 7.8 31 7.8

Total 400 100.0 400 100.0 400 100.0

Sun, sand, surf and surgery in Thailand o

Table 23 The sources of information for choosing the destination in each age reange

The first rank the second

rank the third rank Age Sources of Information No. % No. % No. %

Friends/relative/colleague/experienced person 11 28.2 4 10.3 7 17.8 Internet 11 28.2 13 33.1 2 5.1 Travel Brochure/Guidebook 4 10.3 9 23.1 6 15.4 Newspaper/Magazine 3 7.7 4 10.3 4 10.3 Travel Agency 2 5.1 4 10.3 9 23.1 TV travel program 1 2.6 1 2.6 4 10.3 Tourist boards 2 5.1 1 2.6 3 7.7 Previous Visit 5 12.8 3 7.7 4 10.3

Below 18

Total 39 100.0 39 100.0 39 100.0 Friends/relative/colleague/experienced person 77 30.0 71 27.6 41 16.0 Internet 132 51.4 61 23.8 30 11.7 Travel Brochure/Guidebook 13 5.1 54 21.0 50 19.4 Newspaper/Magazine 3 1.1 16 6.2 39 15.1 Travel Agency 12 4.7 17 6.6 31 12.1 TV travel program 3 1.1 9 3.5 26 10.1 Tourist boards 4 1.5 10 3.9 22 8.6 Previous Visit 13 5.1 19 7.4 18 7.0

18-35

Total 257 100.0 257 100.0 257 100.0 Friends/relative/colleague/experienced person 36 37.9 19 20.0 13 13.7 Internet 29 30.5 20 21.1 11 11.6 Travel Brochure/Guidebook 15 15.8 18 18.9 23 24.2 Newspaper/Magazine 3 3.2 17 17.9 17 17.9 Travel Agency 6 6.3 2 2.1 8 8.4 TV travel program 1 1.0 6 6.3 11 11.6 Tourist boards 3 3.2 4 4.2 4 4.2 Previous Visit 2 2.1 9 9.5 8 8.4

36-65

Total 95 100.0 95 100.0 95 100.0 Friends/relative/colleague/experienced person 2 22.2 2 22.2 1 11.1 Internet 1 11.1 1 11.1 3 33.4 Travel Brochure/Guidebook 3 33.4 4 44.5 1 11.1 Newspaper/Magazine 0 0.0 1 11.1 1 11.1 Travel Agency 0 0.0 1 11.1 1 11.1 TV travel program 1 11.1 0 0.0 1 11.1 Tourist boards 0 0.0 0 0.0 0 0.0

Previous Visit 2 22.2 0 0.0 1 11.1

Over 65

Total 9 100.0 9 100.0 9 100.0

Sun, sand, surf and surgery in Thailand p

Table 24 The important factors to receive a medical treatment


rank the third rank

Factors

No. % No. % No. %

Large spectrum of different treatment 15 3.8 15 3.8 34 8.5

Excellent medical equipment 40 10.0 118 29.5 91 22.8

Professional and qualified medical personnel 231 57.8 73 18.2 34 8.5

Hospitable of a hospital’s staff 17 4.2 23 5.8 55 13.8 Attractive and reasonable prices for treatment 33 8.2 60 15.0 58 14.5

International Accreditation 29 7.2 64 16.0 60 15.0

An interpreter and information in Swedish 20 5.0 23 5.8 28 6.9

An interpreter and information in English 15 3.8 24 5.9 40 10.0

Total 400 100.0 400 100.0 400 100.0

Table 25 The supporting services before and after treatment

the first

rank the second

rank the third

rank Supporting Services

No. % No. % No. %

Flight reservation 21 5.2 48 12.0 53 13.3

Accommodation service 33 8.2 79 19.8 73 18.3

Correspondence with the doctor 251 62.8 47 11.8 34 8.5

Transfer between airport, hotel and hospital 39 9.8 56 14.0 84 20.9

Tourism package 29 7.2 37 9.2 46 11.5

Online consulting service 12 3.0 68 17.0 58 14.5

Follow up visit 15 3.8 65 16.2 52 13.0 Total 400 100.0 400 100.0 400 100.0

Sun, sand, surf and surgery in Thailand q

Table 26 The supporting services before and after treatment in case of different age groups

Ranking order (%) Age supporting services

1st 2nd 3rd

Flight reservation 5.1 12.8 15.4 Accommodation service 5.1 23.1 7.7 Correspondence with the doctor 46.2 10.3 15.4 Transfer between airport, hotel and hospital 20.5 15.4 15.4 Tourism package 10.3 10.2 10.2 Online consulting service 7.7 12.8 12.8 Follow up visit 5.1 15.4 23.1

Below 18

Total 100.0 100.0 100.0


18-36

Total 100.0 100.0 100.0


36-65

Total 100.0 100.0 100.0


Over 65

Total 100.0 100.0 100.0

Sun, sand, surf and surgery in Thailand r

Table 27 The supporting services before and after treatment in case of different occupations

Ranking order (%) Occupations supporting services

1st 2nd 3rd


Government employee

Total 100.0 100.0 100.0


Trade and industry employee

Total 100.0 100.0 100.0


Self-employed

Total 100.0 100.0 100.0


Student

Total 100.0 100.0 100.0


Housewife/ Househusband

Total 100.0 100.0 100.0


Others

Total 100.0 100.0 100.0

Sun, sand, surf and surgery in Thailand s

Table 28 The supporting services before and after treatment in case of different educational background

Ranking order (%) Education supporting services

1st 2nd 3rd

Flight reservation 14.9 14.9 21.3 Accommodation service 4.3 29.8 8.5 Correspondence with the doctor 48.9 6.4 17.0 Transfer between airport, hotel and hospital

8.5 21.3 17.0

Tourism package 14.9 6.4 8.5 Online consulting service 6.4 8.5 14.9 Follow up visit 2.1 12.7 12.8

Nine-year compulsory school

Total 100.0 100.0 100.0


10.7 14.1 20.4


Upper secondary school

Total 100.0 100.0 100.0


8.8 11.6 23.1


University/university college degree

Total 100.0 100.0 100.0

Table 29 Mean of interest in the medical treatments

Medical Treatments N Mean Std. Deviation Annual check-ups 400 2.27 1.487 Dental treatment 400 2.97 1.513 LASIK 400 2.40 1.445 MRI scanning 400 2.01 1.271 Rejuvenation treatments 400 1.95 1.278 Plastic surgery 400 1.95 1.335 Hip or knee replacements 400 2.11 1.354 Urgent treatment 400 2.33 1.572

“Sun, sand, surf, and surgery in Thailand”

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